Learning as It Relates to Addiction Recovery: A Case Study of the Learning Experiences of Men in a Faith-Based Addiction Recovery Program

ERIC Educational Resources Information Center

Voigt, Thomas J. K.

2013-01-01

This case study is about learning as it relates to addiction recovery within the Men's Ministry (a pseudonym) program at an urban, faith-based mission, hereafter referred to as WCM (an acronym). The program is free and long-term residential. Its purpose is to be a "life transformation ministry for troubled men whose lives are out of control…

Neck postures in air traffic controllers with and without neck/shoulder disorders.

PubMed

Arvidsson, Inger; Hansson, Gert-Ake; Mathiassen, Svend Erik; Skerfving, Staffan

2008-03-01

Prolonged computer work with an extended neck is commonly believed to be associated with an increased risk of neck-shoulder disorders. The aim of this study was to compare neck postures during computer work between female cases with neck-shoulder disorders, and healthy referents. Based on physical examinations, 13 cases and 11 referents were selected among 70 female air traffic controllers with the same computer-based work tasks and identical workstations. Postures and movements were measured by inclinometers, placed on the forehead and upper back (C7/Th1) during authentic air traffic control. A recently developed method was applied to assess flexion/extension in the neck, calculated as the difference between head and upper back flexion/extension. cases and referents did not differ significantly in neck posture (median neck flexion/extension: -10 degrees vs. -9 degrees ; p=0.9). Hence, the belief that neck extension posture is associated with neck-shoulder disorders in computer work is not supported by the present data.

Predicting the decisions of hospital based child protection teams to report to child protective services, police and community welfare services.

PubMed

Benbenishty, Rami; Jedwab, Merav; Chen, Wendy; Glasser, Saralee; Slutzky, Hanna; Siegal, Gil; Lavi-Sahar, Zohar; Lerner-Geva, Liat

2014-01-01

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement. Copyright © 2013 Elsevier Ltd. All rights reserved.

Diagnostic accuracy of administrative data algorithms in the diagnosis of osteoarthritis: a systematic review.

PubMed

Shrestha, Swastina; Dave, Amish J; Losina, Elena; Katz, Jeffrey N

2016-07-07

Administrative health care data are frequently used to study disease burden and treatment outcomes in many conditions including osteoarthritis (OA). OA is a chronic condition with significant disease burden affecting over 27 million adults in the US. There are few studies examining the performance of administrative data algorithms to diagnose OA. The purpose of this study is to perform a systematic review of administrative data algorithms for OA diagnosis; and, to evaluate the diagnostic characteristics of algorithms based on restrictiveness and reference standards. Two reviewers independently screened English-language articles published in Medline, Embase, PubMed, and Cochrane databases that used administrative data to identify OA cases. Each algorithm was classified as restrictive or less restrictive based on number and type of administrative codes required to satisfy the case definition. We recorded sensitivity and specificity of algorithms and calculated positive likelihood ratio (LR+) and positive predictive value (PPV) based on assumed OA prevalence of 0.1, 0.25, and 0.50. The search identified 7 studies that used 13 algorithms. Of these 13 algorithms, 5 were classified as restrictive and 8 as less restrictive. Restrictive algorithms had lower median sensitivity and higher median specificity compared to less restrictive algorithms when reference standards were self-report and American college of Rheumatology (ACR) criteria. The algorithms compared to reference standard of physician diagnosis had higher sensitivity and specificity than those compared to self-reported diagnosis or ACR criteria. Restrictive algorithms are more specific for OA diagnosis and can be used to identify cases when false positives have higher costs e.g. interventional studies. Less restrictive algorithms are more sensitive and suited for studies that attempt to identify all cases e.g. screening programs.

Case Study of Childhood Disintegrative Disorder--Heller's Syndrome.

ERIC Educational Resources Information Center

Bray, Melissa A.; Kehle, Thomas J.; Theodore, Lea A.; Broudy, Matthew S.

2002-01-01

Discusses the case of a 25-year-old male with childhood disintegrative disorder (CDD), or Heller's syndrome, in terms of differential diagnosis, progression of the disorder, and suggestions for home- and school-based interventions. Documents the progressive deterioration of cognitive and social competencies. (Contains 23 references.) (GCP)

Task-Based Interaction and Incidental Vocabulary Learning: A Case Study.

ERIC Educational Resources Information Center

Newton, Jonathan

1995-01-01

This case study examined the vocabulary gains made by an adult learner of English as a Second Language as a result of performing four communication tasks. It found that explicit negotiation of word meaning appeared less deterministic of posttest improvements than use of words in the process of completing the task. (13 references) (MDM)

Mapping the literature of case management nursing.

PubMed

White, Pamela; Hall, Marilyn E

2006-04-01

Nursing case management provides a continuum of health care services for defined groups of patients. Its literature is multidisciplinary, emphasizing clinical specialties, case management methodology, and the health care system. This study is part of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association. The study identifies core journals cited in case management literature and indexing services that access those journals. Three source journals were identified based on established criteria, and cited references from each article published from 1997 to 1999 were analyzed. Nearly two-thirds of the cited references were from journals; others were from books, monographs, reports, government documents, and the Internet. Cited journal references were ranked in descending order, and Bradford's Law of Scattering was applied. The many journals constituting the top two zones reflect the diversity of this field. Zone 1 included journals from nursing administration, case management, general medicine, medical specialties, and social work. Two databases, PubMed/MEDLINE and OCLC ArticleFirst, provided the best indexing coverage. Collections that support case management require a relatively small group of core journals. Students and health care professionals will need to search across disciplines to identify appropriate literature.

Responding to abuse: Children's experiences of child protection in a central district, Uganda.

PubMed

Child, Jennifer Christine; Naker, Dipak; Horton, Jennifer; Walakira, Eddy Joshua; Devries, Karen M

2014-10-01

Part of a comprehensive response to violence against children involves child protection systems, but there are few data available on such systems in low-income countries. This study describes the characteristics and help seeking behavior of children referred to local child protection services and the quality of the first-line response in one district in Uganda. Participants included 3,706 children from 42 primary schools who participated in a baseline survey on violence as part of the Good Schools Study (NCT01678846, clinicaltrial.gov). Children who disclosed violence were referred according to predefined criteria based on the type, severity, and timeframe of their experiences. Children were followed up to 4 months after the study ended. First-line responses by receiving agencies were classified into 3 categories: plan for action only, some action taken, and no plan and no action taken. Appropriateness of responses was based on which agency responded, timeliness of the response, quality of the documentation, and final status of the case. From the baseline survey, 529 children (14%) were referred. Girls were more likely to be referred and to meet the criteria for a serious case (9% girls, 4% boys). In total, 104 referrals (20%) had some kind of concrete action taken, but only 20 (3.8%) cases met all criteria for having received an adequate response. Nearly half (43%) of referred children had ever sought help by disclosing their experiences of violence prior to the baseline survey. In our study areas, the first-line response to children's reports of abuse was poor even though some referral structures are in place. Copyright © 2014 Elsevier Ltd. All rights reserved.

What's Eating Gilbert Grape?: A Case Study of Chronic Illness

ERIC Educational Resources Information Center

Alexander, Matthew; Waxman, Dael; White, Patricia

2006-01-01

Cinemeducation refers to the use of movies or movie clips to educate learners about the psychosocial aspects of health care. This paper describes the use of a clip from the movie, "What's Eating Gilbert Grape?" to teach medical students about chronic illness. The clip is used to set up a case study based on the lead character, Gilbert…

Use of a United States-based laboratory as a hematopathology reference center for a developing country: logistics and results.

PubMed

Deetz, C O; Scott, M G; Ladenson, J H; Seyoum, M; Hassan, A; Kreisel, F H; Nguyen, T T; Frater, J L

2013-02-01

With proper logistical support and sponsorship, a laboratory in an industrialized nation might be able to act as a reference laboratory for clinicians based in a developing country. We built on previous experience in the clinical laboratory to see whether a specialized histopathology service (hematopathology) could be provided to a developing country without the expertise or experience to do it in country. Over an 13-year period, 582 cases from 579 individuals were analyzed. Principal pathologic findings included acute leukemia in 84 cases (14%), dyspoiesis in one or more of the hematopoietic lineages in 65 cases (11%, including three cases with high-grade myelodysplasia), 23 cases (4%) with findings suspicious for a chronic myeloproliferative disorder, 35 cases (6%) with findings suspicious for a lymphoproliferative disorder, and infectious organisms (presumably Leishmania in most instances) in 9 (1%) of cases. Specimens from 45 cases (8%) were unsatisfactory owing to extreme hemodilution and/or specimen degeneration. With proper support, a medical laboratory in an industrialized nation may serve as a reference facility for a developing nation. The use of existing infrastructure may be remarkably effective to achieve optimal turnaround time. Although the lack of ancillary studies and follow-up biopsies limit the ability to achieve a definitive diagnosis in many cases, this must be viewed in the context of the limited ability to diagnose or manage hematopoietic neoplasia in developing nations. © 2012 Blackwell Publishing Ltd.

DEB: A Diagnostic Experience Browser using similarity networks

NASA Technical Reports Server (NTRS)

Casadaban, Cyprian E.

1990-01-01

Diagnostic Experience Browser (DEB): a fusion of knowledge base and data base that allows users to examine only the data which is most useful to them is described. The system combines a data base of historical cases of diagnostic trouble-shooting experience with similarity networks. A menu-driven natural language interface receives input about the user's current problem. Similarity networks provide the user with references to past cases that are most similar or most related to those they now face. The user can then choose the case that is most pertinent and browse its full textual description which, in turn, may include references to other related cases.

Physical load during work and leisure time as risk factors for back pain.

PubMed

Hoogendoorn, W E; van Poppel, M N; Bongers, P M; Koes, B W; Bouter, L M

1999-10-01

This systematic review assessed aspects of physical load during work and leisure time as risk factors for back pain. Several reviews on this topic are available, but this one is based on a strict systematic approach to identify and summarize the evidence, comparable with that applied in the clinical literature on the efficacy of intervention for back pain. A computerized bibliographical search was made of several data bases for studies with a cohort or case-referent design. Cross-sectional studies were excluded. A rating system was used to assess the strength of the evidence, based on the methodological quality of 28 cohort and 3 case-referent studies and the consistency of the findings. Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain. The evidence was moderate for patient handling and heavy physical work, and no evidence was found for standing or walking, sitting, sports, and total leisure-time physical activity.

Gold standards and expert panels: a pulmonary nodule case study with challenges and solutions

NASA Astrophysics Data System (ADS)

Miller, Dave P.; O'Shaughnessy, Kathryn F.; Wood, Susan A.; Castellino, Ronald A.

2004-05-01

Comparative evaluations of reader performance using different modalities, e.g. CT with computer-aided detection (CAD) vs. CT without CAD, generally require a "truth" definition based on a gold standard. There are many situations in which a true invariant gold standard is impractical or impossible to obtain. For instance, small pulmonary nodules are generally not assessed by biopsy or resection. In such cases, it is common to use a unanimous consensus or majority agreement from an expert panel as a reference standard for actionability in lieu of the unknown gold standard for disease. Nonetheless, there are three major concerns about expert panel reference standards: (1) actionability is not synonymous with disease (2) it may be possible to obtain different conclusions about which modality is better using different rules (e.g. majority vs. unanimous consensus), and (3) the variability associated with the panelists is not formally captured in the p-values or confidence intervals that are generally produced for estimating the extent to which one modality is superior to the other. A multi-reader-multi-case (MRMC) receiver operating characteristic (ROC) study was performed using 90 cases, 15 readers, and a reference truth based on 3 experienced panelists. The primary analyses were conducted using a reference truth of unanimous consensus regarding actionability (3 out of 3 panelists). To assess the three concerns noted above: (1) additional data from the original radiology reports were compared to the panel (2) the complete analysis was repeated using different definitions of truth, and (3) bootstrap analyses were conducted in which new truth panels were constructed by picking 1, 2, or 3 panelists at random. The definition of the reference truth affected the results for each modality (CT with CAD and CT without CAD) considered by itself, but the effects were similar, so the primary analysis comparing the modalities was robust to the choice of the reference truth.

Choosing relatives for DNA identification of missing persons.

PubMed

Ge, Jianye; Budowle, Bruce; Chakraborty, Ranajit

2011-01-01

DNA-based analysis is integral to missing person identification cases. When direct references are not available, indirect relative references can be used to identify missing persons by kinship analysis. Generally, more reference relatives render greater accuracy of identification. However, it is costly to type multiple references. Thus, at times, decisions may need to be made on which relatives to type. In this study, pedigrees for 37 common reference scenarios with 13 CODIS STRs were simulated to rank the information content of different combinations of relatives. The results confirm that first-order relatives (parents and fullsibs) are the most preferred relatives to identify missing persons; fullsibs are also informative. Less genetic dependence between references provides a higher on average likelihood ratio. Distant relatives may not be helpful solely by autosomal markers. But lineage-based Y chromosome and mitochondrial DNA markers can increase the likelihood ratio or serve as filters to exclude putative relationships. © 2010 American Academy of Forensic Sciences.

Automatic reference selection for quantitative EEG interpretation: identification of diffuse/localised activity and the active earlobe reference, iterative detection of the distribution of EEG rhythms.

PubMed

Wang, Bei; Wang, Xingyu; Ikeda, Akio; Nagamine, Takashi; Shibasaki, Hiroshi; Nakamura, Masatoshi

2014-01-01

EEG (Electroencephalograph) interpretation is important for the diagnosis of neurological disorders. The proper adjustment of the montage can highlight the EEG rhythm of interest and avoid false interpretation. The aim of this study was to develop an automatic reference selection method to identify a suitable reference. The results may contribute to the accurate inspection of the distribution of EEG rhythms for quantitative EEG interpretation. The method includes two pre-judgements and one iterative detection module. The diffuse case is initially identified by pre-judgement 1 when intermittent rhythmic waveforms occur over large areas along the scalp. The earlobe reference or averaged reference is adopted for the diffuse case due to the effect of the earlobe reference depending on pre-judgement 2. An iterative detection algorithm is developed for the localised case when the signal is distributed in a small area of the brain. The suitable averaged reference is finally determined based on the detected focal and distributed electrodes. The presented technique was applied to the pathological EEG recordings of nine patients. One example of the diffuse case is introduced by illustrating the results of the pre-judgements. The diffusely intermittent rhythmic slow wave is identified. The effect of active earlobe reference is analysed. Two examples of the localised case are presented, indicating the results of the iterative detection module. The focal and distributed electrodes are detected automatically during the repeating algorithm. The identification of diffuse and localised activity was satisfactory compared with the visual inspection. The EEG rhythm of interest can be highlighted using a suitable selected reference. The implementation of an automatic reference selection method is helpful to detect the distribution of an EEG rhythm, which can improve the accuracy of EEG interpretation during both visual inspection and automatic interpretation. Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

Mapping the literature of case management nursing

PubMed Central

White, Pamela; Hall, Marilyn E.

2006-01-01

Objectives: Nursing case management provides a continuum of health care services for defined groups of patients. Its literature is multidisciplinary, emphasizing clinical specialties, case management methodology, and the health care system. This study is part of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association. The study identifies core journals cited in case management literature and indexing services that access those journals. Methods: Three source journals were identified based on established criteria, and cited references from each article published from 1997 to 1999 were analyzed. Results: Nearly two-thirds of the cited references were from journals; others were from books, monographs, reports, government documents, and the Internet. Cited journal references were ranked in descending order, and Bradford's Law of Scattering was applied. The many journals constituting the top two zones reflect the diversity of this field. Zone 1 included journals from nursing administration, case management, general medicine, medical specialties, and social work. Two databases, PubMed/MEDLINE and OCLC ArticleFirst, provided the best indexing coverage. Conclusion: Collections that support case management require a relatively small group of core journals. Students and health care professionals will need to search across disciplines to identify appropriate literature. PMID:16710470

An Investigation of Computer-based Simulations for School Crises Management.

ERIC Educational Resources Information Center

Degnan, Edward; Bozeman, William

2001-01-01

Describes development of a computer-based simulation program for training school personnel in crisis management. Addresses the data collection and analysis involved in developing a simulated event, the systems requirements for simulation, and a case study of application and use of the completed simulation. (Contains 21 references.) (Authors/PKP)

Online Resource-Based Learning Environment: Case Studies in Primary Classrooms

ERIC Educational Resources Information Center

So, Winnie Wing Mui; Ching, Fiona Ngai Ying

2012-01-01

This paper discusses the creation of learning environments with online resources by three primary school teachers for pupil's learning of science-related topics with reference to the resource-based e-learning environments (RBeLEs) framework. Teachers' choice of contexts, resources, tools, and scaffolds in designing the learning environments are…

Followership among UK Secondary School Teachers

ERIC Educational Resources Information Center

Francis, Andrew

2014-01-01

This paper reports the preliminary findings of an exploratory study which investigates the followership of longstanding, classroom-based school teachers working in the UK secondary education sector. Using Gronn's (1999) educational leadership formation model as a frame of reference, the study employs a multiple case study methodology with data…

Incidence of cancer and exposure to toluene diisocyanate and methylene diphenyldiisocyanate: a cohort based case-referent study in the polyurethane foam manufacturing industry.

PubMed Central

Hagmar, L; Strömberg, U; Welinder, H; Mikoczy, Z

1993-01-01

OBJECTIVE--To assess the association between occupational exposure to toluene diisocyanate or methylene diphenyldiisocyanate and risk of cancer. DESIGN--A cohort based case-referent study. STUDY BASE--7023 subjects employed during the period 1958 to 1987 in nine Swedish polyurethane foam manufacturing plants. MAIN OUTCOME MEASURES--Odds ratios adjusted with respect to the matching factors (age at risk, calendar year at risk, sex, and plant), calculated from the conditional logistic regression model. RESULTS--A non-significant association was found between high exposure to isocyanates and prostate cancer (OR 2.66, 90% confidence interval (90% CI) 0.39-18.1), which was not enhanced when an induction latency period of 10 years was applied. An association between isocyanate exposure and colon cancer was even weaker. No associations were seen for non-Hodgkin's lymphoma and rectal cancer. CONCLUSIONS--The tentative associations, derived from a previous cohort study, between isocyanate exposure and excess risk for non-Hodgkin's lymphoma and rectal cancer were not supported. Instead, non-significant associations with prostate cancer, and possibly colon cancer, were seen. PMID:8280625

[Study on ethnic medicine quantitative reference herb,Tibetan medicine fruits of Capsicum frutescens as a case].

PubMed

Zan, Ke; Cui, Gan; Guo, Li-Nong; Ma, Shuang-Cheng; Zheng, Jian

2018-05-01

High price and difficult to get of reference substance have become obstacles to HPLC assay of ethnic medicine. A new method based on quantitative reference herb (QRH) was proposed. Specific chromatograms in fruits of Capsicum frutescens were employed to determine peak positions, and HPLC quantitative reference herb was prepared from fruits of C. frutescens. The content of capsaicin and dihydrocapsaicin in the quantitative control herb was determined by HPLC. Eleven batches of fruits of C. frutescens were analyzed with quantitative reference herb and reference substance respectively. The results showed no difference. The present method is feasible for quality control of ethnic medicines and quantitative reference herb is suitable to replace reference substances in assay. Copyright© by the Chinese Pharmaceutical Association.

Preoperative brain shift: study of three surgical cases

NASA Astrophysics Data System (ADS)

El Ganaoui, O.; Morandi, X.; Duchesne, S.; Jannin, P.

2008-03-01

In successful brain tumor surgery, the neurosurgeon's objectives are threefold: (1) reach the target, (2) remove it and (3) preserve eloquent tissue surrounding it. Surgical Planning (SP) consists in identifying optimal access route(s) to the target based on anatomical references and constrained by functional areas. Preoperative images are essential input in Multi-modal Image Guided NeuroSurgery systems (MIGNS) and update of these images, with precision and accuracy, is crucial to approach the anatomical reality in the Operating Room (OR). Intraoperative brain deformation has been previously identified by many research groups and related update of preoperative images has also been studied. We present a study of three surgical cases with tumors accompanied with edema and where corticosteroids were administered and monitored during a preoperative stage [t 0, t I = t 0 + 10 days]. In each case we observed a significant change in the Region Of Interest (ROI) and in anatomical references around it. This preoperative brain shift could induce error for localization during intervention (time t S) if the SP is based on the t 0 preoperative images. We computed volume variation, distance maps based on closest point (CP) for different components of the ROI, and displacement of center of mass (CM) of the ROI. The matching between sets of homologous landmarks from t 0 to t I was performed by an expert. The estimation of the landmarks displacement showed significant deformations around the ROI (landmarks shifted with mean of 3.90 +/- 0.92 mm and maximum of 5.45 mm for one case resection). The CM of the ROI moved about 6.92 mm for one biopsy. Accordingly, there was a sizable difference between SP based at t 0 vs SP based at t I, up to 7.95 mm for localization of reference access in one resection case. When compared to the typical MIGNS system accuracy (2 mm), it is recommended that preoperative images be updated within the interval time [t I,t S] in order to minimize the error correspondence between the anatomical reality and the preoperative data. This should help maximize the accuracy of registration between the preoperative images and the patient in the OR.

PP165. Treatment approaches for preeclampsia: A sample from a big city of a developing country.

PubMed

De Oliveira, L; Rocha, R M; Da Silva, L L; Rosas, C F; Korkes, H; Sass, N

2012-07-01

Preeclampsia is a major cause of maternal morbidity and mortality worldwide, mainly in developing countries. Here we show an example of how is the clinical condition of these patients when they are referred from first care units to a tertiary care teaching maternity in the city of São Paulo, Brazil. To evaluate how has been the approach for preeclamptic women in a big city of Brazil, an example of developing country. This is a retrospective study that evaluated 41 patients that were referred to our hospital from August 2010 to December 2011. In most of the cases patients were referred due to elevations in blood pressure. The diagnosis of preeclampsia was based on the ISSHP recommendations. The diagnosis of severe preeclampsia was based either on clinical symptoms and/or laboratory parameters. Fetal distress was defined when Doppler velocimetry assessment demonstrated abnormal parameters (centralization with abnormal diastolic blood flow at umbilical arteries). Severe preeclampsia was diagnosed in 26 cases (63.4%) and 34 patients were treated with magnesium sulfate (82.9%). One case of eclampsia (2.4%) and five cases of "Abruptio Placentae" (12.1%) were registered. Fetal distress was diagnosed at the moment of admission in 13 cases (31.7%) and two of these fetuses ended in stillbirth (4.8%). Neonatal death occurred in three cases (7.3%), mainly due to extreme preterm delivery. Other outcomes are reported in the following table. ICU: Intensive Care Unit. This is a good example of how has been the approach of preeclamptic women in a big city of Brazil. Our results suggest that a special concern about the moment of referring these patients to tertiary care units should be taken by doctors at first care units. Copyright © 2012. Published by Elsevier B.V.

Occupational medicine specialist referral triggers: Mixed-methods analysis of teleconsult cases.

PubMed

Eaton, J L; Mohammad, A; Mohr, D C; Brustein, D J; Kirkhorn, S R

2017-12-30

Qualitative analyses can yield critical lessons for learning organizations in healthcare. Few studies have applied these techniques in the field of occupational and environmental medicine (OEM). To describe the characteristics of complex cases referred for OEM subspecialty evaluation and variation by referring provider's training. Using a mixed methods approach, we conducted a content analysis of clinical cases submitted to a national OEM teleconsult service. Consecutive cases entered between April 2014 and July 2015 were screened, coded and analysed. 108 cases were available for analysis. Local Veterans Health Administration (VHA) non-specialist providers entered a primary medical diagnosis in 96% of cases at the time of intake. OEM speciality physicians coded significant medical conditions based on free text comments. Coder inter-rater reliability was 84%. The most frequent medical diagnosis types associated with tertiary OEM referral by non-specialists were endocrine (19%), cardiovascular (18%) and mental health (16%). Concern for usage of controlled and/or sedating medications was cited in 1% of cases. Compared to referring non-specialists, OEM physicians were more likely to attribute case complexity to musculoskeletal (OR: 2.3, 1.68-3.14) or neurological (OR: 1.69, 1.28-2.24) conditions. Medication usage (OR: 2.2, 1.49-2.26) was more likely to be a source of clinical concern among referring providers. The findings highlight the range of triggers for OEM physician subspecialty referral in clinical practice with employee patients. The results of this study can be used to inform development of provider education, standardized clinical practice pathways, and quality review activities for occupational medicine practitioners. Published by Oxford University Press on behalf of The Society of Occupational Medicine 2017.

Leaching from solid waste incineration ashes used in cement-treated base layers for pavements.

PubMed

Cai, Z; Bager, Dirch H; Christensen, T H

2004-01-01

Waste incineration bottom ash and treated flue gas cleaning products mixed with 2.5% of cement (50 kg/m3) were tested in the laboratory in terms of compressive strength and tank leaching tests over a 64-day period. Although the material displayed lower mechanical strength than a reference concrete, the strength still was sufficient for use as a base layer for roads. The metal content in the incineration-residue-based specimens was up to 100 times higher than in the reference concrete, suggesting that the mixed waste incineration residue should be used only for dedicated purposes. The leaching of Cl and Na was increased by a factor of 20-100 from the incineration-residue-based specimens as compared to the reference, while the leaching of K, Ca and SO4 was increased by a factor of 2-10. The leaching of heavy metals was also higher from the incineration-residue-based specimens than from the reference with respect to Cu (50 times), Cd, Pb and Zn (5 times), but not with respect to Cr and Ni. The leaching curves did only allow for a closer evaluation of the leaching process in a few cases. The physical retention of the constituents seemed to be the same in the reference as in the incineration-residue-based specimens. Heavy metal leaching was limited by enhanced chemical retention in the incineration-residue-specimens as compared to the reference. Since no quality criteria in terms of leaching from a monolithic material are currently available, the leaching issue must be evaluated case by case.

Education and Social Innovation: The Youth Uncensored Project--A Case Study of Youth Participatory Research and Cultural Democracy in Action

ERIC Educational Resources Information Center

Conrad, Diane H.

2015-01-01

This article discusses social innovation in education informed by arts-based and Indigenous ways of knowing. I use the term Indigenous to refer to First Peoples' and their wisdom traditions from places around the world and the term Aboriginal to refer to the diverse First Nations, Métis, and Inuit peoples of Canada. The article looks at the…

Animal welfare and the refinement of neuroscience research methods--a case study of Huntington's disease models.

PubMed

Olsson, I Anna S; Hansen, Axel K; Sandøe, Peter

2008-07-01

The use of animals in biomedical and other research presents an ethical dilemma: we do not want to lose scientific benefits, nor do we want to cause laboratory animals to suffer. Scientists often refer to the potential human benefits of animal models to justify their use. However, even if this is accepted, it still needs to be argued that the same benefits could not have been achieved with a mitigated impact on animal welfare. Reducing the adverse effects of scientific protocols ('refinement') is therefore crucial in animal-based research. It is especially important that researchers share knowledge on how to avoid causing unnecessary suffering. We have previously demonstrated that even in studies in which animal use leads to spontaneous death, scientists often fail to report measures to minimize animal distress (Olsson et al. 2007). In this paper, we present the full results of a case study examining reports, published in peer-reviewed journals between 2003 and 2004, of experiments employing animal models to study the neurodegenerative disorder Huntington's disease. In 51 references, experiments in which animals were expected to develop motor deficits so severe that they would have difficulty eating and drinking normally were conducted, yet only three references were made to housing adaptation to facilitate food and water intake. Experiments including end-stages of the disease were reported in 14 papers, yet of these only six referred to the euthanasia of moribund animals. If the reference in scientific publications reflects the actual application of refinement, researchers do not follow the 3Rs (replacement, reduction, refinement) principle. While in some cases, it is clear that less-than-optimal techniques were used, we recognize that scientists may apply refinement without referring to it; however, if they do not include such information in publications, it suggests they find it less relevant. Journal publishing policy could play an important role: first, in ensuring that referees seriously consider whether submitted studies were indeed carried out with the smallest achievable negative impact on the animals and, secondly, in encouraging scientists to share refinements through the inclusion of a 3Rs section in papers publishing the results of animal-based research.

Web-GIS oriented systems viability for municipal solid waste selective collection optimization in developed and transient economies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rada, E.C., E-mail: Elena.Rada@ing.unitn.it; Ragazzi, M.; Fedrizzi, P.

Highlights: ► As an appropriate solution for MSW management in developed and transient countries. ► As an option to increase the efficiency of MSW selective collection. ► As an opportunity to integrate MSW management needs and services inventories. ► As a tool to develop Urban Mining actions. - Abstract: Municipal solid waste management is a multidisciplinary activity that includes generation, source separation, storage, collection, transfer and transport, processing and recovery, and, last but not least, disposal. The optimization of waste collection, through source separation, is compulsory where a landfill based management must be overcome. In this paper, a few aspectsmore » related to the implementation of a Web-GIS based system are analyzed. This approach is critically analyzed referring to the experience of two Italian case studies and two additional extra-European case studies. The first case is one of the best examples of selective collection optimization in Italy. The obtained efficiency is very high: 80% of waste is source separated for recycling purposes. In the second reference case, the local administration is going to be faced with the optimization of waste collection through Web-GIS oriented technologies for the first time. The starting scenario is far from an optimized management of municipal solid waste. The last two case studies concern pilot experiences in China and Malaysia. Each step of the Web-GIS oriented strategy is comparatively discussed referring to typical scenarios of developed and transient economies. The main result is that transient economies are ready to move toward Web oriented tools for MSW management, but this opportunity is not yet well exploited in the sector.« less

Comparative study of an argon plasma and an argon copper plasma produced by an ICP torch at atmospheric pressure based on spectroscopic methods

NASA Astrophysics Data System (ADS)

Bussière, W.; Vacher, D.; Menecier, S.; André, P.

2012-04-01

In three places in this paper, the citation of reference [43] quotes a further reference [61] cited therein. This in fact should be the reference [45] cited in [43]. This occurs in the caption of figure 3; at the top of the right-hand column on page 6; and in the paragraph headed Influence of the Biberman factor value on page 18. In each case, the text: '[43] (especially reference [61] therein)' should be replaced by '[43] (especially reference [45] therein)'. The authors would like to thank Dr L G D'yachkov for having pointed out the error.

The contribution of a non-governmental organisation's Community Based Tuberculosis Care Programme to case finding in Myanmar: trend over time.

PubMed

Maung, Htet Myet Win; Saw, Saw; Isaakidis, Petros; Khogali, Mohammed; Reid, Anthony; Hoa, Nguyen Binh; Zaw, Ko Ko; Thein, Saw; Aung, Si Thu

2017-04-03

It is estimated that the standard, passive case finding (PCF) strategy for detecting cases of tuberculosis (TB) in Myanmar has not been successful: 26% of cases are missing. Therefore, alternative strategies, such as active case finding (ACF) by community volunteers, have been initiated since 2011. This study aimed to assess the contribution of a Community Based TB Care Programme (CBTC) by local non-government organizations (NGOs) to TB case finding in Myanmar over 4 years. This was a descriptive study using routine, monitoring data. Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database. Data from all 84 project townships in five regions and three states in Myanmar were used. The project was launched in 2011. Over time, the number of presumptive TB cases that were referred decreased, except in the Yangon Region, although in some areas, the numbers fluctuated. At the same time, there was a trend for the proportion of cases treated, compared to those referred, that decreased over time (P = 0.051). Overall, among 84 townships, the contribution of CBTC to total case detection deceased from 6% to 4% over time (P < 0.001). Contrary to expectations and evidence from previous studies in other countries, a concerning reduction in TB case finding by local NGO volunteer networks in several areas in Myanmar was recorded over 4 years. This suggests that measures to support the volunteer network and improve its performance are needed. They may include discussion with local NGOs human resources personnel, incentives for the volunteers, closer supervision of volunteers and improved monitoring and evaluation tools.

Evidence-based Draft Guideline for Prevention of Midwifery Malpractices based on Referred Cases to the Forensic Medicine Commission and the Medical Council from 2006-2011.

PubMed

Asadi, Leila; Beigi, Marjan; Valiani, Mahbube; Mardani, Fardin

2017-01-01

Medical errors are the main concerns in health systems, which considering their ascending rate in the recent years, especially in the field of midwifery, have caused a medical crisis. Considering the importance of evidence-based health services as a way to improve health systems, the aim of this study was to suggest a guideline for preventing malpractice in midwifery services. In this cross-sectional study that was conducted in 2013, we investigated 206 cases that were referred to the Isfahan Legal Medicine Organization and Medical Council of Forensic Medicine from 2006-2011. Data were collected by a checklist and were analyzed using SPSS-16 software. Descriptive statistical tests (mean, maximum, minimum, standard deviation, frequency, and percentage agreement) were used to describe the data. Then, we used the Delphi technique with the participation from 17 experts in midwifery, gynecology, and legal medicine to provide an evidence-based draft guideline for prevention of midwifery errors. A total of 206 cases were reviewed. In 66 cases (32%) the verdict for malpractice in midwifery services was approved. A practical draft guideline for preventing clinical errors for midwifery in the fields of pregnancy, delivery, and postpartum period was developed. This evidence-based draft guideline can improve the attention of all the healthcare providers, especially midwives and physicians to prevent urgent problems and offer effective health services for mothers and infants.

Evidence-based Draft Guideline for Prevention of Midwifery Malpractices based on Referred Cases to the Forensic Medicine Commission and the Medical Council from 2006–2011

PubMed Central

Asadi, Leila; Beigi, Marjan; Valiani, Mahbube; Mardani, Fardin

2017-01-01

Background: Medical errors are the main concerns in health systems, which considering their ascending rate in the recent years, especially in the field of midwifery, have caused a medical crisis. Considering the importance of evidence-based health services as a way to improve health systems, the aim of this study was to suggest a guideline for preventing malpractice in midwifery services. Materials and Methods: In this cross-sectional study that was conducted in 2013, we investigated 206 cases that were referred to the Isfahan Legal Medicine Organization and Medical Council of Forensic Medicine from 2006–2011. Data were collected by a checklist and were analyzed using SPSS-16 software. Descriptive statistical tests (mean, maximum, minimum, standard deviation, frequency, and percentage agreement) were used to describe the data. Then, we used the Delphi technique with the participation from 17 experts in midwifery, gynecology, and legal medicine to provide an evidence-based draft guideline for prevention of midwifery errors. Results: A total of 206 cases were reviewed. In 66 cases (32%) the verdict for malpractice in midwifery services was approved. A practical draft guideline for preventing clinical errors for midwifery in the fields of pregnancy, delivery, and postpartum period was developed. Conclusions: This evidence-based draft guideline can improve the attention of all the healthcare providers, especially midwives and physicians to prevent urgent problems and offer effective health services for mothers and infants. PMID:28904546

A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

PubMed

Hiligsmann, Mickaël; Cooper, Cyrus; Guillemin, Francis; Hochberg, Marc C; Tugwell, Peter; Arden, Nigel; Berenbaum, Francis; Boers, Maarten; Boonen, Annelies; Branco, Jaime C; Maria-Luisa, Brandi; Bruyère, Olivier; Gasparik, Andrea; Kanis, John A; Kvien, Tore K; Martel-Pelletier, Johanne; Pelletier, Jean-Pierre; Pinedo-Villanueva, Rafael; Pinto, Daniel; Reiter-Niesert, Susanne; Rizzoli, René; Rovati, Lucio C; Severens, Johan L; Silverman, Stuart; Reginster, Jean-Yves

2014-12-01

General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate therapeutic strategies of OA in terms of costs and effectiveness. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Molecular taxonomy of phytopathogenic fungi: a case study in Peronospora.

PubMed

Göker, Markus; García-Blázquez, Gema; Voglmayr, Hermann; Tellería, M Teresa; Martín, María P

2009-07-29

Inappropriate taxon definitions may have severe consequences in many areas. For instance, biologically sensible species delimitation of plant pathogens is crucial for measures such as plant protection or biological control and for comparative studies involving model organisms. However, delimiting species is challenging in the case of organisms for which often only molecular data are available, such as prokaryotes, fungi, and many unicellular eukaryotes. Even in the case of organisms with well-established morphological characteristics, molecular taxonomy is often necessary to emend current taxonomic concepts and to analyze DNA sequences directly sampled from the environment. Typically, for this purpose clustering approaches to delineate molecular operational taxonomic units have been applied using arbitrary choices regarding the distance threshold values, and the clustering algorithms. Here, we report on a clustering optimization method to establish a molecular taxonomy of Peronospora based on ITS nrDNA sequences. Peronospora is the largest genus within the downy mildews, which are obligate parasites of higher plants, and includes various economically important pathogens. The method determines the distance function and clustering setting that result in an optimal agreement with selected reference data. Optimization was based on both taxonomy-based and host-based reference information, yielding the same outcome. Resampling and permutation methods indicate that the method is robust regarding taxon sampling and errors in the reference data. Tests with newly obtained ITS sequences demonstrate the use of the re-classified dataset in molecular identification of downy mildews. A corrected taxonomy is provided for all Peronospora ITS sequences contained in public databases. Clustering optimization appears to be broadly applicable in automated, sequence-based taxonomy. The method connects traditional and modern taxonomic disciplines by specifically addressing the issue of how to optimally account for both traditional species concepts and genetic divergence.

Molecular Taxonomy of Phytopathogenic Fungi: A Case Study in Peronospora

PubMed Central

Göker, Markus; García-Blázquez, Gema; Voglmayr, Hermann; Tellería, M. Teresa; Martín, María P.

2009-01-01

Background Inappropriate taxon definitions may have severe consequences in many areas. For instance, biologically sensible species delimitation of plant pathogens is crucial for measures such as plant protection or biological control and for comparative studies involving model organisms. However, delimiting species is challenging in the case of organisms for which often only molecular data are available, such as prokaryotes, fungi, and many unicellular eukaryotes. Even in the case of organisms with well-established morphological characteristics, molecular taxonomy is often necessary to emend current taxonomic concepts and to analyze DNA sequences directly sampled from the environment. Typically, for this purpose clustering approaches to delineate molecular operational taxonomic units have been applied using arbitrary choices regarding the distance threshold values, and the clustering algorithms. Methodology Here, we report on a clustering optimization method to establish a molecular taxonomy of Peronospora based on ITS nrDNA sequences. Peronospora is the largest genus within the downy mildews, which are obligate parasites of higher plants, and includes various economically important pathogens. The method determines the distance function and clustering setting that result in an optimal agreement with selected reference data. Optimization was based on both taxonomy-based and host-based reference information, yielding the same outcome. Resampling and permutation methods indicate that the method is robust regarding taxon sampling and errors in the reference data. Tests with newly obtained ITS sequences demonstrate the use of the re-classified dataset in molecular identification of downy mildews. Conclusions A corrected taxonomy is provided for all Peronospora ITS sequences contained in public databases. Clustering optimization appears to be broadly applicable in automated, sequence-based taxonomy. The method connects traditional and modern taxonomic disciplines by specifically addressing the issue of how to optimally account for both traditional species concepts and genetic divergence. PMID:19641601

Criminal investigation of child sexual abuse: a comparison of cases referred to the prosecutor to those not referred.

PubMed

Stroud, D D; Martens, S L; Barker, J

2000-05-01

The present study sought to identify characteristics of child sexual abuse cases which differentiate cases referred for criminal prosecution ("criminal-action") from those not referred ("dropped") by investigators. The study sample consisted of 1043 children who completed a forensic interview for sexual abuse that allegedly occurred at the hands of an adult between January 1, 1993 and December 31, 1996 in Bernalillo County of New Mexico. Data was systematically obtained from forensic interview files and offender records at the local prosecutor's office. Differences between criminal-action and dropped cases were found in relation to the children (age, sex and ethnicity), the alleged offenders (age, sex and relationship to child), and the case characteristics (disclosure and injury to the child). The present study provided insight into the characteristics of a previously ignored population (reported child sexual abuse cases that are not referred for prosecution). Recommendations are made to address the needs of these children and their families.

Temperamental reactivity and negative emotionality in uncooperative children referred to specialized paediatric dentistry compared to children in ordinary dental care.

PubMed

Arnrup, Kristina; Broberg, Anders G; Berggren, Ulf; Bodin, Lennart

2007-11-01

Current treatment of children with dental behaviour management problems (DBMP) is based on the presupposition that their difficulties are caused by dental fear, but is this always the case? The aim of this study was to study temperamental reactivity, negative emotionality, and other personal characteristics in relation to DBMP in 8- to 12-year-old children. Forty-six children referred because of DBMP (study group) and 110 children in ordinary dental care (reference group) participated. The EASI tempramental survey assessed temperamental reactivity and negative emotionality, the Child Behaviour Questionnaire internalizing and externalizing behaviour problems, and the Children's Fear Survey Schedule general and dental fears. Cluster analyses and tree-based modelling were used for data analysis. Among the five clusters identified, one could be characterized as 'balanced temperament'. Thirty-five per cent of the reference group compared to only 7% of the study group belonged to this cluster. Negative emotionality was the most important sorting variable. Children referred because of DBMP differed from children in ordinary dental care, not only in dental fear level, but also in personal characteristics. Few of the referred children were characterized by a balanced temperament profile. It is important to consider the dual impact of emotion dysregulation and emotional reactivity in the development of DBMP.

Motion of a Point Mass in a Rotating Disc: A Quantitative Analysis of the Coriolis and Centrifugal Force

NASA Astrophysics Data System (ADS)

Haddout, Soufiane

2016-06-01

In Newtonian mechanics, the non-inertial reference frames is a generalization of Newton's laws to any reference frames. While this approach simplifies some problems, there is often little physical insight into the motion, in particular into the effects of the Coriolis force. The fictitious Coriolis force can be used by anyone in that frame of reference to explain why objects follow curved paths. In this paper, a mathematical solution based on differential equations in non-inertial reference is used to study different types of motion in rotating system. In addition, the experimental data measured on a turntable device, using a video camera in a mechanics laboratory was conducted to compare with mathematical solution in case of parabolically curved, solving non-linear least-squares problems, based on Levenberg-Marquardt's and Gauss-Newton algorithms.

Sample size of the reference sample in a case-augmented study.

PubMed

Ghosh, Palash; Dewanji, Anup

2017-05-01

The case-augmented study, in which a case sample is augmented with a reference (random) sample from the source population with only covariates information known, is becoming popular in different areas of applied science such as pharmacovigilance, ecology, and econometrics. In general, the case sample is available from some source (for example, hospital database, case registry, etc.); however, the reference sample is required to be drawn from the corresponding source population. The required minimum size of the reference sample is an important issue in this regard. In this work, we address the minimum sample size calculation and discuss related issues. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Research, Practice, and Policy Connections: The Artplay Case Study

ERIC Educational Resources Information Center

Brown, Robert; Jeanneret, Neryl

2017-01-01

This article explores the nexus between arts-based research, theory, practice, and policy. It does so through reference to a longitudinal study of ArtPlay, a unique Australian community arts center that offers artist-led workshops involving young people aged 3-13 years. The ethnographic and action research study investigated how children responded…

Knowledge Work and Telework: An Exploratory Study.

ERIC Educational Resources Information Center

Bentley, Kaye; Yoong, Pak

2000-01-01

Describes a case study conducted in New Zealand that investigated how knowledge workers used home-based teleworking, using information and Internet technology. Discusses findings that indicate a preference for doing most work at the office, and considers implications for human resources management, practice, and research. (Contains 26 references.)…

Support and monitoring of families after child abuse detection based on parental characteristics at the Emergency Department.

PubMed

Diderich, H M; Pannebakker, F D; Dechesne, M; Buitendijk, S E; Oudesluys-Murphy, A M

2015-03-01

The 'Hague Protocol' enables professionals at the adult Emergency Department (ED) to detect child abuse based on three parental characteristics: (i) suicide attempt or self-harm, (ii) domestic violence or (iii) substance abuse, and to refer them to the Reporting Centre for Child Abuse and Neglect (RCCAN). This study investigates what had happened to the families three months after this referral. ED referrals based on parental characteristics (N = 100) in which child abuse was confirmed after investigation by the RCCAN were analysed. Information was collected regarding type of child abuse, reason for reporting, duration of problems prior to the ED referral, previous involvement of support services or other agencies, re-occurrence of the problems and outcome of the RCCAN monitoring according to professionals and the families. Of the 100 referred cases, 68 families were already known to the RCCAN, the police or family support services, prior to the ED referral. Of the 99 cases where information was available, existing support was continued or intensified in 31, a Child Protection Services (CPS) report had to be made in 24, new support was organized for 27 cases and in 17 cases support was not necessary, because the domestic problems were already resolved. Even though the RCCAN is mandated to monitor all referred families after three months, 31 cases which were referred internally were not followed up. Before referral by the ED two thirds of these families were already known to organizations. Monitoring may help provide a better, more sustained service and prevent and resolve domestic problems. A national database could help to link data and to streamline care for victims and families. We recommend a Randomized Controlled Trial to test the effectiveness of this Protocol in combination with the outcomes of the provided family support. © 2014 John Wiley & Sons Ltd.

Analysis of household refrigerators for different testing standards

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bansal, P.K.; McGill, I.

This study highlights the salient differences among various testing standards for household refrigerator-freezers and proposes a methodology for predicting the performance of a single evaporator-based vapor-compression refrigeration system (either refrigerator or freezer) from one test standard (where the test data are available-the reference case) to another (the alternative case). The standards studied during this investigation include the Australian-New Zealand Standard (ANZS), the International Standard (ISO), the American National Standard (ANSI), the Japanese Industrial Standard (JIS), and the Chinese National Standard (CNS). A simple analysis in conjunction with the BICYCLE model (Bansal and Rice 1993) is used to calculate the energymore » consumption of two refrigerator cabinets from the reference case to the alternative cases. The proposed analysis includes the effect of door openings (as required by the JIS) as well as defrost heaters. The analytical results are found to agree reasonably well with the experimental observations for translating energy consumption information from one standard to another.« less

Diagnostic concordance among pathologists interpreting breast biopsy specimens.

PubMed

Elmore, Joann G; Longton, Gary M; Carney, Patricia A; Geller, Berta M; Onega, Tracy; Tosteson, Anna N A; Nelson, Heidi D; Pepe, Margaret S; Allison, Kimberly H; Schnitt, Stuart J; O'Malley, Frances P; Weaver, Donald L

2015-03-17

A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%-77.0%; 5194 of 6900 interpretations). Among invasive carcinoma cases (663 interpretations), 96% (95% CI, 94%-97%) were concordant, and 4% (95% CI, 3%-6%) were underinterpreted; among DCIS cases (2097 interpretations), 84% (95% CI, 82%-86%) were concordant, 3% (95% CI, 2%-4%) were overinterpreted, and 13% (95% CI, 12%-15%) were underinterpreted; among atypia cases (2070 interpretations), 48% (95% CI, 44%-52%) were concordant, 17% (95% CI, 15%-21%) were overinterpreted, and 35% (95% CI, 31%-39%) were underinterpreted; and among benign cases without atypia (2070 interpretations), 87% (95% CI, 85%-89%) were concordant and 13% (95% CI, 11%-15%) were overinterpreted. Disagreement with the reference diagnosis was statistically significantly higher among biopsies from women with higher (n = 122) vs lower (n = 118) breast density on prior mammograms (overall concordance rate, 73% [95% CI, 71%-75%] for higher vs 77% [95% CI, 75%-80%] for lower, P < .001), and among pathologists who interpreted lower weekly case volumes (P < .001) or worked in smaller practices (P = .034) or nonacademic settings (P = .007). In this study of pathologists, in which diagnostic interpretation was based on a single breast biopsy slide, overall agreement between the individual pathologists' interpretations and the expert consensus-derived reference diagnoses was 75.3%, with the highest level of concordance for invasive carcinoma and lower levels of concordance for DCIS and atypia. Further research is needed to understand the relationship of these findings with patient management.

Dose-response relationship between cumulative physical workload and osteoarthritis of the hip - a meta-analysis applying an external reference population for exposure assignment.

PubMed

Seidler, Andreas; Lüben, Laura; Hegewald, Janice; Bolm-Audorff, Ulrich; Bergmann, Annekatrin; Liebers, Falk; Ramdohr, Christina; Romero Starke, Karla; Freiberg, Alice; Unverzagt, Susanne

2018-06-01

There is consistent evidence from observational studies of an association between occupational lifting and carrying of heavy loads and the diagnosis of hip osteoarthritis. However, due to the heterogeneity of exposure estimates considered in single studies, a dose-response relationship between cumulative physical workload and hip osteoarthritis could not be determined so far. This study aimed to analyze the dose-response relationship between cumulative physical workload and hip osteoarthritis by replacing the exposure categories of the included studies with cumulative exposure values of an external reference population. Our meta-regression analysis was based on a recently conducted systematic review (Bergmann A, Bolm-Audorff U, Krone D, Seidler A, Liebers F, Haerting J, Freiberg A, Unverzagt S, Dtsch Arztebl Int 114:581-8, 2017). The main analysis of our meta-regression comprised six case-control studies for men and five for women. The population control subjects of a German multicentre case-control study (Seidler A, Bergmann A, Jäger M, Ellegast R, Ditchen D, Elsner G, Grifka J, Haerting J, Hofmann F, Linhardt O, Luttmann A, Michaelis M, Petereit-Haack G, Schumann B, Bolm-Audorff U, BMC Musculoskelet Disord 10:48, 2009) served as the reference population. Based on the sex-specific cumulative exposure percentiles of the reference population, we assigned exposure values to each category of the included studies using three different cumulative exposure parameters. To estimate the doubling dose (the amount of physical workload to double the risk of hip osteoarthritis) on the basis of all available case-control-studies, meta-regression analyses were conducted based on the linear association between exposure values of the reference population and the logarithm of reported odds ratios (ORs) from the included studies. In men, the risk to develop hip osteoarthritis was increased by an OR of 1.98 (95% CI 1.20-3.29) per 10,000 tons of weights ≥20 kg handled, 2.08 (95% CI 1.22-3.53) per 10,000 tons handled > 10 times per day and 8.64 (95% CI 1.87-39.91) per 10 6 operations. These estimations result in doubling dosages of 10,100 tons of weights ≥20 kg handled, 9500 tons ≥20 kg handled > 10 times per day and 321,400 operations of weights ≥20 kg. There was no linear association between manual handling of weights at work and risk to develop hip osteoarthritis in women. Under specific conditions, the application of an external reference population allows for the derivation of a dose-response relationship despite high exposure heterogeneities in the pooled studies.

Referred knee pain in a young athlete: a case study.

PubMed

Tippett, S R

1994-02-01

Parapatellar pain is a common complaint in the active adolescent patient population. Patello-femoral pain syndrome, Osgood-Schlatter disease, Sinding-Larsen-Johansson syndrome, patellar tendinitis, and other stress failure conditions are the primary causes of these parapatellar symptoms. Not all cases of knee discomfort are related to knee pathology. This case study discusses hip pathology as a source of referred knee pain in an 8-year-old male athlete. Care must be taken to evaluate all possible sources of both primary and referred pain in all cases.

Implementation of a National Reference Laboratory for Buruli Ulcer Disease in Togo

PubMed Central

Badziklou, Kossi; Halatoko, Wemboo Afiwa; Maman, Issaka; Vogel, Felix; Bidjada, Bawimodom; Awoussi, Koffi Somenou; Piten, Ebekalisai; Helfrich, Kerstin; Mengele, Carolin; Nitschke, Jörg; Amekuse, Komi; Wiedemann, Franz Xaver; Diefenhardt, Adolf; Kobara, Basile; Herbinger, Karl–Heinz; Kere, Abiba Banla; Prince-David, Mireille; Löscher, Thomas; Bretzel, Gisela

2013-01-01

Background In a previous study PCR analysis of clinical samples from suspected cases of Buruli ulcer disease (BUD) from Togo and external quality assurance (EQA) for local microscopy were conducted at an external reference laboratory in Germany. The relatively poor performance of local microscopy as well as effort and time associated with shipment of PCR samples necessitated the implementation of stringent EQA measures and availability of local laboratory capacity. This study describes the approach to implementation of a national BUD reference laboratory in Togo. Methodology Large scale outreach activities accompanied by regular training programs for health care professionals were conducted in the regions “Maritime” and “Central,” standard operating procedures defined all processes in participating laboratories (regional, national and external reference laboratories) as well as the interaction between laboratories and partners in the field. Microscopy was conducted at regional level and slides were subjected to EQA at national and external reference laboratories. For PCR analysis, sample pairs were collected and subjected to a dry-reagent-based IS2404-PCR (DRB-PCR) at national level and standard IS2404 PCR followed by IS2404 qPCR analysis of negative samples at the external reference laboratory. Principal Findings The inter-laboratory concordance rates for microscopy ranged from 89% to 94%; overall, microscopy confirmed 50% of all suspected BUD cases. The inter-laboratory concordance rate for PCR was 96% with an overall PCR case confirmation rate of 78%. Compared to a previous study, the rate of BUD patients with non-ulcerative lesions increased from 37% to 50%, the mean duration of disease before clinical diagnosis decreased significantly from 182.6 to 82.1 days among patients with ulcerative lesions, and the percentage of category III lesions decreased from 30.3% to 19.2%. Conclusions High inter-laboratory concordance rates as well as case confirmation rates of 50% (microscopy), 71% (PCR at national level), and 78% (including qPCR confirmation at external reference laboratory) suggest high standards of BUD diagnostics. The increase of non-ulcerative lesions, as well as the decrease in diagnostic delay and category III lesions, prove the effect of comprehensive EQA and training measures involving also procedures outside the laboratory. PMID:23359828

Implementation of a national reference laboratory for Buruli ulcer disease in Togo.

PubMed

Beissner, Marcus; Huber, Kristina Lydia; Badziklou, Kossi; Halatoko, Wemboo Afiwa; Maman, Issaka; Vogel, Felix; Bidjada, Bawimodom; Awoussi, Koffi Somenou; Piten, Ebekalisai; Helfrich, Kerstin; Mengele, Carolin; Nitschke, Jörg; Amekuse, Komi; Wiedemann, Franz Xaver; Diefenhardt, Adolf; Kobara, Basile; Herbinger, Karl-Heinz; Kere, Abiba Banla; Prince-David, Mireille; Löscher, Thomas; Bretzel, Gisela

2013-01-01

In a previous study PCR analysis of clinical samples from suspected cases of Buruli ulcer disease (BUD) from Togo and external quality assurance (EQA) for local microscopy were conducted at an external reference laboratory in Germany. The relatively poor performance of local microscopy as well as effort and time associated with shipment of PCR samples necessitated the implementation of stringent EQA measures and availability of local laboratory capacity. This study describes the approach to implementation of a national BUD reference laboratory in Togo. Large scale outreach activities accompanied by regular training programs for health care professionals were conducted in the regions "Maritime" and "Central," standard operating procedures defined all processes in participating laboratories (regional, national and external reference laboratories) as well as the interaction between laboratories and partners in the field. Microscopy was conducted at regional level and slides were subjected to EQA at national and external reference laboratories. For PCR analysis, sample pairs were collected and subjected to a dry-reagent-based IS2404-PCR (DRB-PCR) at national level and standard IS2404 PCR followed by IS2404 qPCR analysis of negative samples at the external reference laboratory. The inter-laboratory concordance rates for microscopy ranged from 89% to 94%; overall, microscopy confirmed 50% of all suspected BUD cases. The inter-laboratory concordance rate for PCR was 96% with an overall PCR case confirmation rate of 78%. Compared to a previous study, the rate of BUD patients with non-ulcerative lesions increased from 37% to 50%, the mean duration of disease before clinical diagnosis decreased significantly from 182.6 to 82.1 days among patients with ulcerative lesions, and the percentage of category III lesions decreased from 30.3% to 19.2%. High inter-laboratory concordance rates as well as case confirmation rates of 50% (microscopy), 71% (PCR at national level), and 78% (including qPCR confirmation at external reference laboratory) suggest high standards of BUD diagnostics. The increase of non-ulcerative lesions, as well as the decrease in diagnostic delay and category III lesions, prove the effect of comprehensive EQA and training measures involving also procedures outside the laboratory.

Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens

PubMed Central

Elmore, Joann G.; Longton, Gary M.; Carney, Patricia A.; Geller, Berta M.; Onega, Tracy; Tosteson, Anna N. A.; Nelson, Heidi D.; Pepe, Margaret S.; Allison, Kimberly H.; Schnitt, Stuart J.; O’Malley, Frances P.; Weaver, Donald L.

2015-01-01

IMPORTANCE A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. OBJECTIVES To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. DESIGN, SETTING, AND PARTICIPANTS Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. EXPOSURES Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. MAIN OUTCOMES AND MEASURES The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. RESULTS Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%–77.0%; 5194 of 6900 interpretations). Consensus ReferenceDiagnosis Pathologist Interpretation vs Consensus-Derived Reference Diagnosis, % (95% CI) No. ofInterpretations Overall ConcordanceRate OverinterpretationRate UnderinterpretationRate Benign without atypia 2070 87 (85–89) 13 (11–15) Atypia 2070 48 (44–52) 17 (15–21) 35 (31–39) DCIS 2097 84 (82–86) 3 (2–4) 13 (12–15) Invasive carcinoma 663 96 (94–97) 4 (3–6) Disagreement with the reference diagnosis was statistically significantly higher among biopsies from women with higher (n = 122) vs lower (n = 118) breast density on prior mammograms (overall concordance rate, 73% [95% CI, 71%–75%] for higher vs 77% [95% CI, 75%–80%] for lower, P < .001), and among pathologists who interpreted lower weekly case volumes (P < .001) or worked in smaller practices (P = .034) or nonacademic settings (P = .007). CONCLUSIONS AND RELEVANCE In this study of pathologists, in which diagnostic interpretation was based on a single breast biopsy slide, overall agreement between the individual pathologists’ interpretations and the expert consensus–derived reference diagnoses was 75.3%, with the highest level of concordance for invasive carcinoma and lower levels of concordance for DCIS and atypia. Further research is needed to understand the relationship of these findings with patient management. PMID:25781441

Criminal Investigation of Child Sexual Abuse: A Comparison of Cases Referred to the Prosecutor to Those Not Referred.

ERIC Educational Resources Information Center

Stroud, Delores D.; Martens, Sonja L.; Barker, Julia

2000-01-01

This study compared characteristics of child sexual abuse cases either referred for criminal prosecution (N=587) or dropped (N=456) by investigators. Differences were found between groups in relation to child characteristics (age, sex, and ethnicity), offender characteristics (age, sex, and relationship to child), and case characteristics…

Inter-Agency Approaches to the Development of a School-Based Student Health Service

ERIC Educational Resources Information Center

Harrison, Jane; Bullock, Jane

2005-01-01

Young people living in rural areas lack opportunities for accessing health advice and care without reference to a parent, carer, or other adult. In this article Jane Harrison and Jane Bullock provide the rationale for the development in 1997 of Bodyzone, a school-based health service to address this problem. Presented here as a case study,…

Two-year-olds exclude novel objects as potential referents of novel words based on pragmatics.

PubMed

Grassmann, Susanne; Stracke, Marén; Tomasello, Michael

2009-09-01

Many studies have established that children tend to exclude objects for which they already have a name as potential referents of novel words. In the current study we asked whether this exclusion can be triggered by social-pragmatic context alone without pre-existing words as blockers. Two-year-old children watched an adult looking at a novel object while saying a novel word with excitement. In one condition the adult had not seen the object beforehand, and so the children interpreted the adult's utterance as referring to the gazed-at object. In another condition the adult and child had previously played jointly with the gazed-at object. In this case, children less often assumed that the adult was referring to the object but rather they searched for an alternative referent--presumably because they inferred that the gazed-at object was old news in their common ground with the adult and so not worthy of excited labeling. Since this inference based on exclusion is highly similar to that underlying the Principle of Contrast/Mutual Exclusivity, we propose that this principle is not purely lexical but rather is based on children's understanding of how and why people direct one another's attention to things either with or without language.

32 CFR 842.121 - Referring a claim to the US Attorney.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Referring a claim to the US Attorney. 842.121... to the US Attorney. Only HQ USAF/JACC authorizes referral of a claim to the US Attorney. The base SJA...-case basis, HQ USAF/JACC will authorize referral of a case to the US Attorney by telephone. ...

International non-governmental organizations' provision of community-based tuberculosis care for hard-to-reach populations in Myanmar, 2013-2014.

PubMed

Soe, Kyaw Thu; Saw, Saw; van Griensven, Johan; Zhou, Shuisen; Win, Le; Chinnakali, Palanivel; Shah, Safieh; Mon, Myo Myo; Aung, Si Thu

2017-03-24

National tuberculosis (TB) programs increasingly engage with international non-governmental organizations (INGOs), especially to provide TB care in complex settings where community involvement might be required. In Myanmar, however, there is limited data on how such INGO community-based programs are organized and how effective they are. In this study, we describe four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar, and assess their contribution to TB case detection. We conducted a descriptive study using program data from four INGOs and the National TB Program (NTP) in 2013-2014. For each INGO, we extracted information on its approach and key activities, the number of presumptive TB cases referred and undergoing TB testing, and the number of patients diagnosed with TB and their treatment outcomes. The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships. All four INGOs implemented community-based TB care in challenging contexts, targeting migrants, post-conflict areas, the urban poor, and other vulnerable populations. Two recruited community volunteers via existing community health volunteers or health structures, one via existing community leaderships, and one directly involved TB infected/affected individuals. Two INGOs compensated volunteers via performance-based financing, and two provided financial and in-kind initiatives. All relied on NTP laboratories for diagnosis and TB drugs, but provided direct observation treatment support and treatment follow-up. A total of 21 995 presumptive TB cases were referred for TB diagnosis, with 7 383 (34%) new TB cases diagnosed and almost all (98%) successfully treated. The four INGOs contributed to the detection of, on average, 36% (7 383/20 663) of the total new TB cases in their respective townships (range: 15-52%). Community-based TB care supported by INGOs successfully achieved TB case detection in hard-to-reach and vulnerable populations. This is vital to achieving the World Health Organization End TB Strategy targets. Strategies to ensure sustainability of the programs should be explored, including the need for longer-term commitment of INGOs.

Learning to Explain Astronomy Across Moving Frames of Reference: Exploring the role of classroom and planetarium-based instructional contexts

NASA Astrophysics Data System (ADS)

Plummer, Julia Diane; Kocareli, Alicia; Slagle, Cynthia

2014-05-01

Learning astronomy involves significant spatial reasoning, such as learning to describe Earth-based phenomena and understanding space-based explanations for those phenomena as well as using the relevant size and scale information to interpret these frames of reference. This study examines daily celestial motion (DCM) as one case of how children learn to move between frames of reference in astronomy wherein one explains Earth-based descriptions of the Sun's, Moon's, and stars' apparent motion using the Earth's daily rotation. We analysed interviews with 8-9-year-old students (N = 99) who participated in one of four instructional conditions emphasizing: the space-based perspective; the Earth-based perspective in the planetarium; constructing explanations for the Earth-based observations; and a combination of the planetarium plus constructing explanations in the classroom. We used an embodied cognition framework to analyse outcomes while also considering challenges learners face due to the high cognitive demands of spatial reasoning. Results support the hypothesis that instruction should engage students in learning both the Earth-based observations and space-based explanations, as focusing on a single frame of reference resulted in less sophisticated explanations; however, few students were able to construct a fully scientific explanation after instruction.

Primary Care-Based Memory Clinics: Expanding Capacity for Dementia Care.

PubMed

Lee, Linda; Hillier, Loretta M; Heckman, George; Gagnon, Micheline; Borrie, Michael J; Stolee, Paul; Harvey, David

2014-09-01

The implementation in Ontario of 15 primary-care-based interprofessional memory clinics represented a unique model of team-based case management aimed at increasing capacity for dementia care at the primary-care level. Each clinic tracked referrals; in a subset of clinics, charts were audited by geriatricians, clinic members were interviewed, and patients, caregivers, and referring physicians completed satisfaction surveys. Across all clinics, 582 patients were assessed, and 8.9 per cent were referred to a specialist. Patients and caregivers were very satisfied with the care received, as were referring family physicians, who reported increased capacity to manage dementia. Geriatricians' chart audits revealed a high level of agreement with diagnosis and management. This study demonstrated acceptability, feasibility, and preliminary effectiveness of the primary-care memory clinic model. Led by specially trained family physicians, it provided timely access to high-quality collaborative dementia care, impacting health service utilization by more-efficient use of scarce geriatric specialist resources.

Statistical analysis of electromagnetic radiation measurements in the vicinity of GSM/UMTS base station installed on buildings in Serbia.

PubMed

Koprivica, Mladen; Slavkovic, Vladimir; Neskovic, Natasa; Neskovic, Aleksandar

2016-03-01

As a result of dense deployment of public mobile base stations, additional electromagnetic (EM) radiation occurs in the modern human environment. At the same time, public concern about the exposure to EM radiation emitted by such sources has increased. In order to determine the level of radio frequency radiation generated by base stations, extensive EM field strength measurements were carried out for 664 base station locations, from which 276 locations refer to the case of base stations with antenna system installed on buildings. Having in mind the large percentage (42 %) of locations with installations on buildings, as well as the inevitable presence of people in their vicinity, a detailed analysis of this location category was performed. Measurement results showed that the maximum recorded value of total electric field strength has exceeded International Commission on Non-Ionizing Radiation Protection general public exposure reference levels at 2.5 % of locations and Serbian national reference levels at 15.6 % of locations. It should be emphasised that the values exceeding the reference levels were observed only outdoor, while in indoor total electric field strength in no case exceeded the defined reference levels. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Project-Approach to GIS as an Integrative Classroom Technology: An Environmental Case Study.

ERIC Educational Resources Information Center

Gatrell, Jay D.; Oshiro, Kenji K.

2001-01-01

Explains how Geographic Information Systems (GIS) influences geography curricula and how project-based learning can be applied to GIS experiences. Introduces a project investigating non-geography college students' design and implementation of a environmental GIS application. (Contains 16 references.) (YDS)

Helping Elementary-Age Children Cope with Disasters.

ERIC Educational Resources Information Center

Shen, Yih-Jiun; Sink, Christopher A.

2002-01-01

This article addresses the effects of disasters on elementary-age children and their needs for mental health. Suggests possible school-based interventions and provides a case study of a traumatized first-grader, demonstrating how child- centered play therapy can be used in school settings. (Contains 57 references.) (GCP)

Radiotherapy supporting system based on the image database using IS&C magneto-optical disk

NASA Astrophysics Data System (ADS)

Ando, Yutaka; Tsukamoto, Nobuhiro; Kunieda, Etsuo; Kubo, Atsushi

1994-05-01

Since radiation oncologists make the treatment plan by prior experience, information about previous cases is helpful in planning the radiation treatment. We have developed an supporting system for the radiation therapy. The case-based reasoning method was implemented in order to search old treatments and images of past cases. This system evaluates similarities between the current case and all stored cases (case base). The portal images of the similar cases can be retrieved for reference images, as well as treatment records which show examples of the radiation treatment. By this system radiotherapists can easily make suitable plans of the radiation therapy. This system is useful to prevent inaccurate plannings due to preconceptions and/or lack of knowledge. Images were stored into magneto-optical disks and the demographic data is recorded to the hard disk which is equipped in the personal computer. Images can be displayed quickly on the radiotherapist's demands. The radiation oncologist can refer past cases which are recorded in the case base and decide the radiation treatment of the current case. The file and data format of magneto-optical disk is the IS&C format. This format provides the interchangeability and reproducibility of the medical information which includes images and other demographic data.

Isocyanate exposure and occupational asthma: a case-referent study

PubMed Central

Meredith, S; Bugler, J; Clark, R

2000-01-01

OBJECTIVE—To examine the quantitative relation between exposure to isocyanates and occupational asthma, and to explore the role of atopy and smoking in occurrence of the disease.
METHOD—A case-referent study was undertaken of cases from two manufacturing companies (A and B) from which referents without disease could be selected and reliable exposure measurements were available. In company A, 27 cases mainly attributed to toluene diisocyanate (TDI) were matched to 51 referents on work area, start and duration of employment, sex, and age. Exposures were estimated from existing measurements by job category. In company B there were seven cases attributed to 4,4'-diphenylmethane diisocyanate (MDI) in two areas of the plant; 12 non-cases from the same areas were used as referents. Personal exposure measurements were available for all cases and 11 referents.
RESULTS—No difference in peak exposures between cases and referents was found in either plant; but in both, time weighted average (TWA) exposures at the time of onset of asthma were higher for cases. In A, the mean TWA exposure for cases was 1.5 (95% confidence interval (95% CI) 1.2 to 1.8) ppb compared with 1.2 (1.0 to 1.4) ppb for referents. From a matched analysis, the odds ratio (OR) associated with 8 hour TWA exposure to isocyanates greater than 1.125 ppb (the median concentration for the referent group) was 3.2 (95% CI 0.96 to 10.6; p=0.06). Occupational asthma was associated with a pre-employment history of atopic illness (OR 3.5, p=0.04) and, less strongly, with smoking (OR 2.1, p=0.14). In B, small numbers limited analysis, but three of seven cases had at least one TWA exposure measurement greater than 5 ppb compared with one of 11 referents (OR 7.5, p=0.09).
CONCLUSION—Asthma can occur at low concentrations of isocyanates, but even at low concentrations, the higher the exposure the greater the risk. By contrast with other studies, smoking and atopy seemed to increase the odds of occupational asthma due to isocyanates, but did not affect the estimate of risk associated with exposure.


Keywords: occupational asthma; isocyanates PMID:11077012

Comparing The Effects Of Reference Pricing And Centers-Of-Excellence Approaches To Value-Based Benefit Design.

PubMed

Zhang, Hui; Cowling, David W; Facer, Matthew

2017-12-01

Various health insurance benefit designs based on value-based purchasing have been promoted to steer patients to high-value providers, but little is known about the designs' relative effectiveness and underlying mechanisms. We compared the impact of two designs implemented by the California Public Employees' Retirement System on inpatient hospital total hip or knee replacement: a reference-based pricing design for preferred provider organizations (PPOs) and a centers-of-excellence design for health maintenance organizations (HMOs). Payment and utilization data for the procedures in the period 2008-13 were evaluated using pre-post and quasi-experimental designs at the system and health plan levels, adjusting for demographic characteristics, case-mix, and other confounders. We found that both designs prompted higher use of designated low-price high-quality facilities and reduced average replacement expenses per member at the plan and system levels. However, the designs used different routes: The reference-based pricing design reduced average replacement payments per case in PPOs by 26.7 percent in the first year, compared to HMOs, but did not lower PPO members' utilization rates. In contrast, the centers-of-excellence design lowered HMO members' utilization rates by 29.2 percent in the first year, compared to PPOs, but did not reduce HMO average replacement payments per case. The reference-based pricing design appears more suitable for reducing price variation, and the centers-of-excellence design for addressing variation in use.

He Asked Me What!?--Using Shared Online Accounts as Training Tools for Distance Learning Librarians

ERIC Educational Resources Information Center

Robinson, Kelly; Casey, Anne Marie; Citro, Kathleen

2017-01-01

This study explores the idea of creating a knowledge base from shared online accounts to use in training librarians who perform distance reference services. Through a survey, follow-up interviews and a case study, the investigators explored current and potential use of shared online accounts as training tools. This study revealed that the…

InSAR datum connection using GNSS-augmented radar transponders

NASA Astrophysics Data System (ADS)

Mahapatra, Pooja; der Marel, Hans van; van Leijen, Freek; Samiei-Esfahany, Sami; Klees, Roland; Hanssen, Ramon

2018-01-01

Deformation estimates from Interferometric Synthetic Aperture Radar (InSAR) are relative: they form a `free' network referred to an arbitrary datum, e.g. by assuming a reference point in the image to be stable. However, some applications require `absolute' InSAR estimates, i.e. expressed in a well-defined terrestrial reference frame, e.g. to compare InSAR results with those of other techniques. We propose a methodology based on collocated InSAR and Global Navigation Satellite System (GNSS) measurements, achieved by rigidly attaching phase-stable millimetre-precision compact active radar transponders to GNSS antennas. We demonstrate this concept through a simulated example and practical case studies in the Netherlands.

[Bibliographical study of Minamata disease].

PubMed

Ishihara, Nobuo

2002-01-01

In 1958, Minamata Disease was suggested to be organic mercury compounds intoxication. This suggestion was based on Hunter and Russel's report on occupational exposure to methylmercury. This report is known to have established the typical symptoms of methyl mercury intoxication. However, it has been widely believed since the official recognition of Minamata Disease (1956) that, at the moment of outbreak, no reports were available on organic mercury formation from inorganic mercury in acetaldehyde production from acetylene, or on organic mercury intoxication among workers in acetaldehyde production from acetylene. However, this was not the case. The formation of organic mercury from inorganic mercury used as a catalyst was reported by Vogt and Nieuwland in 1921. In 1930, Zangger reported several cases of organic mercury intoxication among workers in acetaldehyde production from acetylene. Soon after, Koelsch reported that the cases were methyl- and/or ethylmercury intoxication, and that such cases had been common since 1916. These reports were already available at the time of the Minamata Disease outbreak. However, Zangger's report, the most important of these three was not referred to until 1987, notwithstanding its listing in the references of Kurland et al.. Zangger's report was not referred to not by investigators, but by a lawyer. If these reports had been referred to at the outbreak of Minamata Disease, the number of victims in Minamata would have been minimized, and Minamata Disease in Niigata would have been prevented.

Unconventional tail configurations for transport aircraft

NASA Astrophysics Data System (ADS)

Sánchez-Carmona, A.; Cuerno-Rejado, C.; García-Hernández, L.

2017-06-01

This article presents the bases of a methodology in order to size unconventional tail configurations for transport aircraft. The case study of this paper is a V-tail con¦guration. Firstly, an aerodynamic study is developed for determining stability derivatives and aerodynamic forces. The objective is to size a tail such as it develops at least the same static stability derivatives than a conventional reference aircraft. The optimum is obtained minimizing its weight. The weight is estimated through two methods: adapted Farrar£s method and a statistical method. The solution reached is heavier than the reference, but it reduces the wetted area.

Injury profiles related to mortality in patients with a low Injury Severity Score: a case-mix issue?

PubMed

Joosse, Pieter; Schep, Niels W L; Goslings, J Carel

2012-07-01

Outcome prediction models are widely used to evaluate trauma care. External benchmarking provides individual institutions with a tool to compare survival with a reference dataset. However, these models do have limitations. In this study, the hypothesis was tested whether specific injuries are associated with increased mortality and whether differences in case-mix of these injuries influence outcome comparison. A retrospective study was conducted in a Dutch trauma region. Injury profiles, based on injuries most frequently endured by unexpected death, were determined. The association between these injury profiles and mortality was studied in patients with a low Injury Severity Score by logistic regression. The standardized survival of our population (Ws statistic) was compared with North-American and British reference databases, with and without patients suffering from previously defined injury profiles. In total, 14,811 patients were included. Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic injuries were significantly associated with mortality corrected for age, sex, and physiologic derangement in patients with a low injury severity. Odds ratios ranged from 2.42 to 2.92. The Ws statistic for comparison with North-American databases significantly improved after exclusion of patients with these injuries. The Ws statistic for comparison with a British reference database remained unchanged. Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic wall injuries are associated with increased mortality. Comparative outcome analysis of a population with a reference database that differs in case-mix with respect to these injuries should be interpreted cautiously. Prognostic study, level II.

Neo-Nationalism in Higher Education: Case of South Africa

ERIC Educational Resources Information Center

Lee, Jenny J.

2017-01-01

Given the rise of regional hubs, emerging economies are experiencing international student growth as higher education providers in their respective regions. This study examined the neo-national experiences of international students in South Africa. Neo-nationalism refers to a new nationalism based national order in the new global economy. The…

DETECTABILITY AND UNCERTAINTIES IN THE ESTIMATION OF THE IMPACTS OF LAND DISTURBANCES ON CATCHMENT RUNOFF

EPA Science Inventory

Interpretation of the impacts of land disturbances on hydrology is confounded by climate variations. Clear definition of the anthropogenic impacts has been difficult, especially in cases where a clearly defined base line or reference point is absent. This study investigates the d...

Context for Communication: Teaching Expertise through Case-Based In-Basket Exercises.

ERIC Educational Resources Information Center

Stearns, James M.; Ronald, Kate; Greenlee, Timothy B.; Crespy, Charles T.

2003-01-01

Case-based in-basket exercises require students to master content as well as communicate knowledge to professional audiences. The combination of specialized content knowledge and analysis of communication contexts helps develop expertise. (Contains 23 references and an in-basket example.) (SK)

Managing risks of noncancer health effects at hazardous waste sites: A case study using the Reference Concentration (RfC) of trichloroethylene (TCE).

PubMed

Dourson, Michael L; Gadagbui, Bernard K; Thompson, Rod B; Pfau, Edward J; Lowe, John

2016-10-01

A method for determining a safety range for non-cancer risks is proposed, similar in concept to the range used for cancer in the management of waste sites. This safety range brings transparency to the chemical specific Reference Dose or Concentration by replacing their "order of magnitude" definitions with a scientifically-based range. EPA's multiple RfCs for trichloroethylene (TCE) were evaluated as a case study. For TCE, a multi-endpoint safety range was judged to be 3 μg/m(3) to 30 μg/m,(3) based on a review of kidney effects found in NTP (1988), thymus effects found in Keil et al. (2009) and cardiac effects found in the Johnson et al. (2003) study. This multi-endpoint safety range is derived from studies for which the appropriate averaging time corresponds to different exposure durations, and, therefore, can be applied to both long- and short-term exposures with appropriate consideration of exposure averaging times. For shorter-term exposures, averaging time should be based on the time of cardiac development in humans during fetal growth, an average of approximately 20-25 days. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

Variability in Pathologists’ Interpretations of Individual Breast Biopsy Slides: A Population Perspective

PubMed Central

Elmore, Joann G.; Nelson, Heidi D.; Pepe, Margaret S.; Longton, Gary M.; Tosteson, Anna N.A.; Geller, Berta; Onega, Tracy; Carney, Patricia A.; Jackson, Sara L.; Allison, Kimberly H.; Weaver, Donald L.

2016-01-01

Background The effect of physician diagnostic variability on accuracy at a population level depends on the prevalence of diagnoses. Objective To estimate how diagnostic variability affects accuracy from the perspective of a U.S. woman aged 50 to 59 years having a breast biopsy. Design Applied probability using Bayes theorem. Setting B-Path (Breast Pathology) Study comparing pathologists’ interpretations of a single biopsy slide versus a reference consensus interpretation from 3 experts. Participants 115 practicing pathologists (6900 total interpretations from 240 distinct cases). Measurements A single representative slide from each of the 240 cases was used to estimate the proportion of biopsies with a diagnosis that would be verified if the same slide were interpreted by a reference group of 3 expert pathologists. Probabilities of confirmation (predictive values) were estimated using B-Path Study results and prevalence of biopsy diagnoses for women aged 50 to 59 years in the Breast Cancer Surveillance Consortium. Results Overall, if 1 representative slide were used per case, 92.3% (95% CI, 91.4% to 93.1%) of breast biopsy diagnoses would be verified by reference consensus diagnoses, with 4.6% (CI, 3.9% to 5.3%) overinterpreted and 3.2% (CI, 2.7% to 3.6%) underinterpreted. Verification of invasive breast cancer and benign without atypia diagnoses is highly probable; estimated predictive values were 97.7% (CI, 96.5% to 98.7%) and 97.1% (CI, 96.7% to 97.4%), respectively. Verification is less probable for atypia (53.6% overinterpreted and 8.6% underinterpreted) and ductal carcinoma in situ (DCIS) (18.5% overinterpreted and 11.8% underinterpreted). Limitations Estimates are based on a testing situation with 1 slide used per case and without access to second opinions. Population-adjusted estimates may differ for women from other age groups, unscreened women, or women in different practice settings. Conclusion This analysis, based on interpretation of a single breast biopsy slide per case, predicts a low likelihood that a diagnosis of atypia or DCIS would be verified by a reference consensus diagnosis. This diagnostic gray zone should be considered in clinical management decisions in patients with these diagnoses. Primary Funding Source National Cancer Institute. PMID:26999810

Occupational risks and lung cancer burden for Chinese men: a population-based case-referent study.

PubMed

Tse, Lap Ah; Yu, Ignatius Tak-Sun; Qiu, Hong; Au, Joseph Siu Kai; Wang, Xiao-Rong

2012-01-01

We aimed to fill in the gap of knowledge on the lung cancer burden resulting from occupational exposures among Chinese men through a population-based case-referent study. Detailed information on lifestyle and full occupational histories of 1,208 male lung cancer incident cases and 1,069 age-matched male community referents were obtained through interviews during 2004-2006. The associations between lung cancer risk and exposures to specific or group of agents that were confirmed or suspected occupational carcinogens were analyzed. After adjustment of smoking and other potential confounding factors, significant odds ratio of lung cancer was observed for workers employed in major industrial divisions of "construction" (1.37, 95% CI: 1.00-1.89) and "financing, insurance, real estate, and business services" (0.48, 95% CI: 0.23-0.97), as well as in the occupational groups of "bricklayers, carpenters, and other construction workers" (1.49, 95% CI: 1.07-2.06). Significantly elevated odds ratios were found for occupational exposures to silica dust (1.75, 95% CI: 1.16-2.62), welding fumes (1.74, 95% CI: 1.13-2.68), diesel exhaust (2.18, 95% CI: 1.23-3.84), and man-made mineral fibers (7.45, 95% CI: 1.63-34.00), while a significantly reduced risk (OR = 0.67, 95% CI: 0.47-0.95) was linked to cotton dust. The population attributable fraction of lung cancer was 3.2% (95% CI: 0.1-7.3%) for construction workers and 9.5% (95% CI: 4.8-15.1%) for the four significant specific exposures. Our study indicates that previous exposure to occupational carcinogens remains an important determinant of lung cancer burden for Hong Kong Chinese men. However, results obtained from this study should be confirmed by future analyses based on job exposure matrix.

Hippocampal amnesia.

PubMed

Spiers, H J; Maguire, E A; Burgess, N

2001-01-01

This article reviews 147 cases of amnesia following damage including the hippocampus or fornix as reported in 179 publications. The aetiology, mnestic abilities and reference(s) are tabulated for each case. Consistent findings across cases include the association of bilateral hippocampal damage with a deficit in anterograde episodic memory combined with spared procedural and working memory. The limited nature of retrograde amnesia following lesions to the fornix is also noted. Less consistent and thus more controversial findings, include effects of lesion size or laterality, deficits in semantic memory or familiarity-based recognition and the extent of retrograde amnesia. The evidence concerning these issues is reviewed across cases.

Maternal Exposure to Bisphenol-A and Fetal Growth Restriction: A Case-Referent Study

PubMed Central

Burstyn, Igor; Martin, Jonathan W.; Beesoon, Sanjay; Bamforth, Fiona; Li, Qiaozhi; Yasui, Yutaka; Cherry, Nicola M.

2013-01-01

We conducted a case-referent study of the effect of exposure to bisphenol-A on fetal growth in utero in full-term, live-born singletons in Alberta, Canada. Newborns <10 percentile of expected weight for gestational age and sex were individually matched on sex, maternal smoking and maternal age to referents with weight appropriate to gestational age. Exposure of the fetus to bisphenol-A was estimated from maternal serum collected at 15–16 weeks of gestation. We pooled sera across subjects for exposure assessment, stratified on case-referent status and sex. Individual 1:1 matching was maintained in assembling 69 case and 69 referent pools created from 550 case-referent pairs. Matched pools had an equal number of aliquots from individual women. We used an analytical strategy conditioning on matched set and total pool-level values of covariates to estimate individual-level effects. Pools of cases and referents had identical geometric mean bisphenol-A concentrations (0.5 ng/mL) and similar geometric standard deviations (2.3–2.5). Mean difference in concentration between matched pools was 0 ng/mL, standard deviation: 1 ng/mL. Stratification by sex and control for confounding did not suggest bisphenol-A increased fetal growth restriction. Our analysis does not provide evidence to support the hypothesis that bisphenol-A contributes to fetal growth restriction in full-term singletons. PMID:24336026

Robust Vision-Based Pose Estimation Algorithm for AN Uav with Known Gravity Vector

NASA Astrophysics Data System (ADS)

Kniaz, V. V.

2016-06-01

Accurate estimation of camera external orientation with respect to a known object is one of the central problems in photogrammetry and computer vision. In recent years this problem is gaining an increasing attention in the field of UAV autonomous flight. Such application requires a real-time performance and robustness of the external orientation estimation algorithm. The accuracy of the solution is strongly dependent on the number of reference points visible on the given image. The problem only has an analytical solution if 3 or more reference points are visible. However, in limited visibility conditions it is often needed to perform external orientation with only 2 visible reference points. In such case the solution could be found if the gravity vector direction in the camera coordinate system is known. A number of algorithms for external orientation estimation for the case of 2 known reference points and a gravity vector were developed to date. Most of these algorithms provide analytical solution in the form of polynomial equation that is subject to large errors in the case of complex reference points configurations. This paper is focused on the development of a new computationally effective and robust algorithm for external orientation based on positions of 2 known reference points and a gravity vector. The algorithm implementation for guidance of a Parrot AR.Drone 2.0 micro-UAV is discussed. The experimental evaluation of the algorithm proved its computational efficiency and robustness against errors in reference points positions and complex configurations.

Single-Case Experimental Designs to Evaluate Novel Technology-Based Health Interventions

PubMed Central

Cassidy, Rachel N; Raiff, Bethany R

2013-01-01

Technology-based interventions to promote health are expanding rapidly. Assessing the preliminary efficacy of these interventions can be achieved by employing single-case experiments (sometimes referred to as n-of-1 studies). Although single-case experiments are often misunderstood, they offer excellent solutions to address the challenges associated with testing new technology-based interventions. This paper provides an introduction to single-case techniques and highlights advances in developing and evaluating single-case experiments, which help ensure that treatment outcomes are reliable, replicable, and generalizable. These advances include quality control standards, heuristics to guide visual analysis of time-series data, effect size calculations, and statistical analyses. They also include experimental designs to isolate the active elements in a treatment package and to assess the mechanisms of behavior change. The paper concludes with a discussion of issues related to the generality of findings derived from single-case research and how generality can be established through replication and through analysis of behavioral mechanisms. PMID:23399668

Identification and comprehensive evaluation of reference genes for RT-qPCR analysis of host gene-expression in Brassica juncea-aphid interaction using microarray data.

PubMed

Ram, Chet; Koramutla, Murali Krishna; Bhattacharya, Ramcharan

2017-07-01

Brassica juncea is a chief oil yielding crop in many parts of the world including India. With advancement of molecular techniques, RT-qPCR based study of gene-expression has become an integral part of experimentations in crop breeding. In RT-qPCR, use of appropriate reference gene(s) is pivotal. The virtue of the reference genes, being constant in expression throughout the experimental treatments, needs to be validated case by case. Appropriate reference gene(s) for normalization of gene-expression data in B. juncea during the biotic stress of aphid infestation is not known. In the present investigation, 11 reference genes identified from microarray database of Arabidopsis-aphid interaction at a cut off FDR ≤0.1, along with two known reference genes of B. juncea, were analyzed for their expression stability upon aphid infestation. These included 6 frequently used and 5 newly identified reference genes. Ranking orders of the reference genes in terms of expression stability were calculated using advanced statistical approaches such as geNorm, NormFinder, delta Ct and BestKeeper. The analysis suggested CAC, TUA and DUF179 as the most suitable reference genes. Further, normalization of the gene-expression data of STP4 and PR1 by the most and the least stable reference gene, respectively has demonstrated importance and applicability of the recommended reference genes in aphid infested samples of B. juncea. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Recirculating Industrial Air: The Impact on Air Compliance and Workers; Safety Case Study: Hill Air Force Base C-130 Painting Operations.

DTIC Science & Technology

1998-06-29

chromium are Cr° (metal), Cr3+ and Cr6+. The trivalent chromium (Cr3+) and hexavalent chromium (Cr6+) are the most biologically significant. Cr + is...REFERENCES Agency for Toxic Substances and Disease Registry (ATSDR). "Case Studies in Environmental Medicine: Chromium Toxicity," U.S. Department...Wilson B. M. ’The Fate of Hexavalent Chromium in the Atmosphere," Research Triangle Institute RTI/3 798/00- 01F (October 1988). Hughes, S., Ayer, J

Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium: The Time Has Come.

PubMed

Costello, Rebecca B; Elin, Ronald J; Rosanoff, Andrea; Wallace, Taylor C; Guerrero-Romero, Fernando; Hruby, Adela; Lutsey, Pamela L; Nielsen, Forrest H; Rodriguez-Moran, Martha; Song, Yiqing; Van Horn, Linda V

2016-11-01

The 2015 Dietary Guidelines Advisory Committee indicated that magnesium was a shortfall nutrient that was underconsumed relative to the Estimated Average Requirement (EAR) for many Americans. Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially less. A growing body of literature from animal, epidemiologic, and clinical studies has demonstrated a varied pathologic role for magnesium deficiency that includes electrolyte, neurologic, musculoskeletal, and inflammatory disorders; osteoporosis; hypertension; cardiovascular diseases; metabolic syndrome; and diabetes. Studies have also demonstrated that magnesium deficiency is associated with several chronic diseases and that a reduced risk of these diseases is observed with higher magnesium intake or supplementation. Subclinical magnesium deficiency can exist despite the presentation of a normal status as defined within the current serum magnesium reference interval of 0.75-0.95 mmol/L. This reference interval was derived from data from NHANES I (1974), which was based on the distribution of serum magnesium in a normal population rather than clinical outcomes. What is needed is an evidenced-based serum magnesium reference interval that reflects optimal health and the current food environment and population. We present herein data from an array of scientific studies to support the perspective that subclinical deficiencies in magnesium exist, that they contribute to several chronic diseases, and that adopting a revised serum magnesium reference interval would improve clinical care and public health. © 2016 American Society for Nutrition.

Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium: The Time Has Come12345

PubMed Central

Elin, Ronald J; Rosanoff, Andrea; Lutsey, Pamela L; Nielsen, Forrest H; Rodriguez-Moran, Martha

2016-01-01

The 2015 Dietary Guidelines Advisory Committee indicated that magnesium was a shortfall nutrient that was underconsumed relative to the Estimated Average Requirement (EAR) for many Americans. Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially less. A growing body of literature from animal, epidemiologic, and clinical studies has demonstrated a varied pathologic role for magnesium deficiency that includes electrolyte, neurologic, musculoskeletal, and inflammatory disorders; osteoporosis; hypertension; cardiovascular diseases; metabolic syndrome; and diabetes. Studies have also demonstrated that magnesium deficiency is associated with several chronic diseases and that a reduced risk of these diseases is observed with higher magnesium intake or supplementation. Subclinical magnesium deficiency can exist despite the presentation of a normal status as defined within the current serum magnesium reference interval of 0.75–0.95 mmol/L. This reference interval was derived from data from NHANES I (1974), which was based on the distribution of serum magnesium in a normal population rather than clinical outcomes. What is needed is an evidenced-based serum magnesium reference interval that reflects optimal health and the current food environment and population. We present herein data from an array of scientific studies to support the perspective that subclinical deficiencies in magnesium exist, that they contribute to several chronic diseases, and that adopting a revised serum magnesium reference interval would improve clinical care and public health. PMID:28140318

The implementation of aerial object recognition algorithm based on contour descriptor in FPGA-based on-board vision system

NASA Astrophysics Data System (ADS)

Babayan, Pavel; Smirnov, Sergey; Strotov, Valery

2017-10-01

This paper describes the aerial object recognition algorithm for on-board and stationary vision system. Suggested algorithm is intended to recognize the objects of a specific kind using the set of the reference objects defined by 3D models. The proposed algorithm based on the outer contour descriptor building. The algorithm consists of two stages: learning and recognition. Learning stage is devoted to the exploring of reference objects. Using 3D models we can build the database containing training images by rendering the 3D model from viewpoints evenly distributed on a sphere. Sphere points distribution is made by the geosphere principle. Gathered training image set is used for calculating descriptors, which will be used in the recognition stage of the algorithm. The recognition stage is focusing on estimating the similarity of the captured object and the reference objects by matching an observed image descriptor and the reference object descriptors. The experimental research was performed using a set of the models of the aircraft of the different types (airplanes, helicopters, UAVs). The proposed orientation estimation algorithm showed good accuracy in all case studies. The real-time performance of the algorithm in FPGA-based vision system was demonstrated.

Academic Achievement in Adults with a History of Childhood Attention-Deficit/Hyperactivity Disorder: A Population-Based Prospective Study.

PubMed

Voigt, Robert G; Katusic, Slavica K; Colligan, Robert C; Killian, Jill M; Weaver, Amy L; Barbaresi, William J

2017-01-01

Previous research on the developmental course of attention-deficit/hyperactivity disorder (ADHD) is limited by biased clinic-referred samples and other methodological problems. Thus, questions about adult academic outcomes associated with childhood ADHD remain unanswered. Thus, the objective of this study was to describe academic outcomes in adulthood among incident cases of research-identified childhood ADHD versus non-ADHD referents from a population-based birth cohort. Young adults with research-identified childhood ADHD (N = 232; mean age 27.0 yr; 72.0% men) and referents (N = 335; mean age 28.6 yr; 62.7% men) from a 1976 to 1982 birth cohort (N = 5699) were invited to participate in a followup study and were administered an academic achievement battery consisting of the basic reading component of the Woodcock-Johnson III Tests of Achievement (WJ-III) and the arithmetic subtest of the Wide Range Achievement Test-Third Edition (WRAT-3). Outcomes were compared between the 2 groups using linear regression models, adjusted for age, sex, and comorbid learning disability status. Childhood ADHD cases scored from 3 to 5 grade equivalents lower on all academic tests compared with referents, with mean (SD) standard scores of 95.7 (8.4) versus 101.8 (8.1) in basic reading; 95.0 (9.3) versus 101.9 (8.5) in letterword identification; 98.2 (8.6) versus 103.2 (9.2) in passage comprehension; 95.7 (9.1) versus 100.9 (9.0) in word attack; and 87.8 (12.9) versus 98.0 (12.0) in arithmetic. This is the first prospective, population-based study of adult academic outcomes of childhood ADHD. Our data provide evidence that childhood onset ADHD is associated with long-term underachievement in reading and math that may negatively impact ultimate educational attainment and occupational functioning in adulthood.

A broad scope knowledge based model for optimization of VMAT in esophageal cancer: validation and assessment of plan quality among different treatment centers.

PubMed

Fogliata, Antonella; Nicolini, Giorgia; Clivio, Alessandro; Vanetti, Eugenio; Laksar, Sarbani; Tozzi, Angelo; Scorsetti, Marta; Cozzi, Luca

2015-10-31

To evaluate the performance of a broad scope model-based optimisation process for volumetric modulated arc therapy applied to esophageal cancer. A set of 70 previously treated patients in two different institutions, were selected to train a model for the prediction of dose-volume constraints. The model was built with a broad-scope purpose, aiming to be effective for different dose prescriptions and tumour localisations. It was validated on three groups of patients from the same institution and from another clinic not providing patients for the training phase. Comparison of the automated plans was done against reference cases given by the clinically accepted plans. Quantitative improvements (statistically significant for the majority of the analysed dose-volume parameters) were observed between the benchmark and the test plans. Of 624 dose-volume objectives assessed for plan evaluation, in 21 cases (3.3 %) the reference plans failed to respect the constraints while the model-based plans succeeded. Only in 3 cases (<0.5 %) the reference plans passed the criteria while the model-based failed. In 5.3 % of the cases both groups of plans failed and in the remaining cases both passed the tests. Plans were optimised using a broad scope knowledge-based model to determine the dose-volume constraints. The results showed dosimetric improvements when compared to the benchmark data. Particularly the plans optimised for patients from the third centre, not participating to the training, resulted in superior quality. The data suggests that the new engine is reliable and could encourage its application to clinical practice.

Systems Engineering Case Studies: Synopsis of the Learning Principles

DTIC Science & Technology

2010-05-17

Engineering Case Study HST refers to the Hubble Space Telescope Systems Engineering Case Study TBMCS refers to the Theater Battle Management Core System...going to orbit undetected in spite of substantial evidence that could have been used to prevent this occurrence. TBMCS /1 Requirements Definition...baseline was volatile up to system acceptance, which took place after TBMCS passed operational test and evaluation. TBMCS /2 System Architecture The

Nonlinear time-series-based adaptive control applications

NASA Technical Reports Server (NTRS)

Mohler, R. R.; Rajkumar, V.; Zakrzewski, R. R.

1991-01-01

A control design methodology based on a nonlinear time-series reference model is presented. It is indicated by highly nonlinear simulations that such designs successfully stabilize troublesome aircraft maneuvers undergoing large changes in angle of attack as well as large electric power transients due to line faults. In both applications, the nonlinear controller was significantly better than the corresponding linear adaptive controller. For the electric power network, a flexible AC transmission system with series capacitor power feedback control is studied. A bilinear autoregressive moving average reference model is identified from system data, and the feedback control is manipulated according to a desired reference state. The control is optimized according to a predictive one-step quadratic performance index. A similar algorithm is derived for control of rapid changes in aircraft angle of attack over a normally unstable flight regime. In the latter case, however, a generalization of a bilinear time-series model reference includes quadratic and cubic terms in angle of attack.

Environmental and cost life cycle assessment of disinfection options for municipal wastewater treatment

EPA Science Inventory

This document summarizes the data collection, analysis, and results for a base case wastewater treatment (WWT) plant reference model. The base case is modeled after the Metropolitan Sewer District of Greater Cincinnati (MSDGC) Mill Creek Plant. The plant has an activated sludge s...

A new resource for developing and strengthening large-scale community health worker programs.

PubMed

Perry, Henry; Crigler, Lauren; Lewin, Simon; Glenton, Claire; LeBan, Karen; Hodgins, Steve

2017-01-12

Large-scale community health worker programs are now growing in importance around the world in response to the resurgence of interest and growing evidence of the importance of community-based primary health care for improving the health of populations in resource-constrained, high-mortality settings. These programs, because of their scale and operational challenges, merit special consideration by the global health community, national policy-makers, and program implementers. A new online resource is now available to assist in that effort: Developing and Strengthening Community Health Worker Programs at Scale: A Reference Guide and Case Studies for Program Managers and Policymakers ( http://www.mchip.net/CHWReferenceGuide ). This CHW Reference Guide is the product of 27 different collaborators who, collectively, have a formidable breadth and depth of experience and knowledge about CHW programming around the world. It provides a thoughtful discussion about the many operational issues that large-scale CHW programs need to address as they undergo the process of development, expansion or strengthening. Detailed case studies of 12 national CHW programs are included in the Appendix-the most current and complete cases studies as a group that are currently available. Future articles in this journal will highlight many of the themes in the CHW Reference Guide and provide an update of recent advances and experiences. These articles will serve, we hope, to (1) increase awareness about the CHW Reference Guide and its usefulness and (2) connect a broader audience to the critical importance of strengthening large-scale CHW programs for the health benefits that they can bring to underserved populations around the world.

Fuel Cycle Analysis Framework Base Cases for the IAEA/INPRO GAINS Collaborative Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brent Dixon

Thirteen countries participated in the Collaborative Project GAINS “Global Architecture of Innovative Nuclear Energy Systems Based on Thermal and Fast Reactors Including a Closed Fuel Cycle”, which was the primary activity within the IAEA/INPRO Program Area B: “Global Vision on Sustainable Nuclear Energy” for the last three years. The overall objective of GAINS was to develop a standard framework for assessing future nuclear energy systems taking into account sustainable development, and to validate results through sample analyses. This paper details the eight scenarios that constitute the GAINS framework base cases for analysis of the transition to future innovative nuclear energymore » systems. The framework base cases provide a reference for users of the framework to start from in developing and assessing their own alternate systems. Each base case is described along with performance results against the GAINS sustainability evaluation metrics. The eight cases include four using a moderate growth projection and four using a high growth projection for global nuclear electricity generation through 2100. The cases are divided into two sets, addressing homogeneous and heterogeneous scenarios developed by GAINS to model global fuel cycle strategies. The heterogeneous world scenario considers three separate nuclear groups based on their fuel cycle strategies, with non-synergistic and synergistic cases. The framework base case analyses results show the impact of these different fuel cycle strategies while providing references for future users of the GAINS framework. A large number of scenario alterations are possible and can be used to assess different strategies, different technologies, and different assumptions about possible futures of nuclear power. Results can be compared to the framework base cases to assess where these alternate cases perform differently versus the sustainability indicators.« less

Incorporating Library School Interns on Academic Library Subject Teams

ERIC Educational Resources Information Center

Sargent, Aloha R.; Becker, Bernd W.; Klingberg, Susan

2011-01-01

This case study analyzes the use of library school interns on subject-based teams for the social sciences, humanities, and sciences in the San Jose State University Library. Interns worked closely with team librarians on reference, collection development/management, and instruction activities. In a structured focus group, interns reported that the…

Alumni Relations in Chinese HEIs: Case Studies of Three Major Universities

ERIC Educational Resources Information Center

Zhimin, Luo; Chunlian, Chen; Xian, Wang

2016-01-01

Good alumni relations are key to universities and colleges winning support from their graduates. With reference to social capital theory, an important problem in establishing strong alumni relations is how to turn alumni resources, an important university social network, into productive, public, and abundant capital. Based on the established…

Orienting the Work-Based Curriculum Towards Work Process Knowledge: A Rationale and a German Case Study

ERIC Educational Resources Information Center

Boreham, Nick

2004-01-01

The term 'work process knowledge' refers to the knowledge needed for working in flexible and innovative business environments, including those in which information and communication technologies have been introduced to integrate previously separated production functions. It involves a systems-level understanding of the work process in the…

Adapting Compassion Focused Therapy for an Adult with a Learning Disability--A Case Study

ERIC Educational Resources Information Center

Cooper, Rosalind; Frearson, Julia

2017-01-01

Background: Joe was referred to the Community Learning Disabilities Team (CLDT) for support around low mood and overeating. Initial formulation suggested compassion focused therapy (CFT) as an intervention. The evidence base for using CFT with people with learning disabilities is currently limited. Materials and Methods: Adaptations were made to…

Accurate registration of temporal CT images for pulmonary nodules detection

NASA Astrophysics Data System (ADS)

Yan, Jichao; Jiang, Luan; Li, Qiang

2017-02-01

Interpretation of temporal CT images could help the radiologists to detect some subtle interval changes in the sequential examinations. The purpose of this study was to develop a fully automated scheme for accurate registration of temporal CT images for pulmonary nodule detection. Our method consisted of three major registration steps. Firstly, affine transformation was applied in the segmented lung region to obtain global coarse registration images. Secondly, B-splines based free-form deformation (FFD) was used to refine the coarse registration images. Thirdly, Demons algorithm was performed to align the feature points extracted from the registered images in the second step and the reference images. Our database consisted of 91 temporal CT cases obtained from Beijing 301 Hospital and Shanghai Changzheng Hospital. The preliminary results showed that approximately 96.7% cases could obtain accurate registration based on subjective observation. The subtraction images of the reference images and the rigid and non-rigid registered images could effectively remove the normal structures (i.e. blood vessels) and retain the abnormalities (i.e. pulmonary nodules). This would be useful for the screening of lung cancer in our future study.

Stochastic model search with binary outcomes for genome-wide association studies.

PubMed

Russu, Alberto; Malovini, Alberto; Puca, Annibale A; Bellazzi, Riccardo

2012-06-01

The spread of case-control genome-wide association studies (GWASs) has stimulated the development of new variable selection methods and predictive models. We introduce a novel Bayesian model search algorithm, Binary Outcome Stochastic Search (BOSS), which addresses the model selection problem when the number of predictors far exceeds the number of binary responses. Our method is based on a latent variable model that links the observed outcomes to the underlying genetic variables. A Markov Chain Monte Carlo approach is used for model search and to evaluate the posterior probability of each predictor. BOSS is compared with three established methods (stepwise regression, logistic lasso, and elastic net) in a simulated benchmark. Two real case studies are also investigated: a GWAS on the genetic bases of longevity, and the type 2 diabetes study from the Wellcome Trust Case Control Consortium. Simulations show that BOSS achieves higher precisions than the reference methods while preserving good recall rates. In both experimental studies, BOSS successfully detects genetic polymorphisms previously reported to be associated with the analyzed phenotypes. BOSS outperforms the other methods in terms of F-measure on simulated data. In the two real studies, BOSS successfully detects biologically relevant features, some of which are missed by univariate analysis and the three reference techniques. The proposed algorithm is an advance in the methodology for model selection with a large number of features. Our simulated and experimental results showed that BOSS proves effective in detecting relevant markers while providing a parsimonious model.

Factors Associated with Evidence-Based Clinical Questions Presented in a Vertically Integrated Seminar Series at a U.S. Dental School.

PubMed

Shenoy, Gayathri M; Dragan, Irina F; Pagni, Sarah; Murphy, Jennipher; Karimbux, Nadeem

2018-06-01

The Basic Science/Clinical Science Spiral Seminar Series (BaSiCSsss) was implemented at Tufts University School of Dental Medicine in 2013. In the series, teams of dental students from all four years presented components of a clinical case, supported by evidence-based dentistry concepts. The role of the third-year student on each team was to present questions based on the PICO (Population, Intervention, Comparison, Outcome) method to support the treatment plan for the selected case. The primary aim of this study was to identify the dental discipline from which the PICO question was chosen, and the secondary aim was to review the level of evidence (journal impact factor, study design, and year of publication) of sources used to support the PICO questions. Presentations compiled during the 2014-15 and 2015-16 academic years were reviewed. The PICO questions and additional details from the publications used as reference (choice of journal, year of publication, study design) were reviewed. A total of 224 presentations were reviewed. The results showed that most topics were from the subjects of periodontology and prosthodontics. Systematic reviews and cohort studies were the most often used types of study design. The majority of the articles cited were recently published. The students used supporting references for the clinical questions published recently with a high level of evidence.

Lunar in-core thermionic nuclear reactor power system conceptual design

NASA Technical Reports Server (NTRS)

Mason, Lee S.; Schmitz, Paul C.; Gallup, Donald R.

1991-01-01

This paper presents a conceptual design of a lunar in-core thermionic reactor power system. The concept consists of a thermionic reactor located in a lunar excavation with surface mounted waste heat radiators. The system was integrated with a proposed lunar base concept representative of recent NASA Space Exploration Initiative studies. The reference mission is a permanently-inhabited lunar base requiring a 550 kWe, 7 year life central power station. Performance parameters and assumptions were based on the Thermionic Fuel Element (TFE) Verification Program. Five design cases were analyzed ranging from conservative to advanced. The cases were selected to provide sensitivity effects on the achievement of TFE program goals.

Reliable landmarks for precise topographical analyses of pathological structural changes of the ovine tibial plateau in 2-D and 3-D subspaces.

PubMed

Oláh, Tamás; Reinhard, Jan; Gao, Liang; Goebel, Lars K H; Madry, Henning

2018-01-08

Selecting identical topographical locations to analyse pathological structural changes of the osteochondral unit in translational models remains difficult. The specific aim of the study was to provide objectively defined reference points on the ovine tibial plateau based on 2-D sections of micro-CT images useful for reproducible sample harvesting and as standardized landmarks for landmark-based 3-D image registration. We propose 5 reference points, 11 reference lines and 12 subregions that are detectable macroscopically and on 2-D micro-CT sections. Their value was confirmed applying landmark-based rigid and affine 3-D registration methods. Intra- and interobserver comparison showed high reliabilities, and constant positions (standard errors < 1%). Spatial patterns of the thicknesses of the articular cartilage and subchondral bone plate were revealed by measurements in 96 individual points of the tibial plateau. As a case study, pathological phenomena 6 months following OA induction in vivo such as osteophytes and areas of OA development were mapped to the individual subregions. These new reference points and subregions are directly identifiable on tibial plateau specimens or macroscopic images, enabling a precise topographical location of pathological structural changes of the osteochondral unit in both 2-D and 3-D subspaces in a region-appropriate fashion relevant for translational investigations.

Criteria-based audit to improve a district referral system in Malawi: a pilot study.

PubMed

Kongnyuy, Eugene J; Mlava, Grace; van den Broek, Nynke

2008-09-22

To study the feasibility of using criteria-based audit to improve a district referral system. A criteria-based audit was used to assess the Salima District referral system in Malawi. A retrospective review of 60 obstetric emergencies referred from 12 health centres was conducted and compared with prior established standards for optimal referral of emergencies. Recommendations were made and implemented. Three months later, a re-audit was conducted (62 cases). There were significant improvements in 4 out of 7 standards: adequate resuscitation before referral (33.3% vs 88.7%; p = 0.001); delay of less than 2 hours from the time the ambulance is called to when the ambulance brought the patient to the hospital (42.8% vs 88.3%; p = 0.014); clinician attends to patient within 30 minutes of arrival to hospital (30.8% vs 92.6%; p = 0.001) and feedback given to the referring health centres (1.7% vs 91.9%; p <0.001). The rest of the three standards showed a high level of attainment (>95%) in both the initial audit and the re-audit: referred patients accompanied by a referral form; ambulances are available at all times and the district hospital is informed through short-wave radio by the health centre when a patient is referred. Criteria-based audit can improve the ability of a district referral system to handle obstetric emergencies in countries with limited resources.

Pre-service middle school mathematics teachers' evaluations of discussions: the case of proof by contradiction

NASA Astrophysics Data System (ADS)

Demiray, Esra; Işıksal Bostan, Mine

2017-03-01

The purposes of this study are to investigate whether pre-service middle school mathematics teachers evaluate discussions in the cases regarding proof by contradiction correctly, to what extent they explain their correct evaluations by referring to proof by contradiction, and the reasons of their misinterpretations of discussions in the cases regarding proof by contradiction. Data were collected from pre-service middle school mathematics teachers enrolled in a state university in Ankara, Turkey, by asking them to evaluate discussions in two cases related to proof by contradiction. In data analysis, descriptive statistics and item-based analysis were employed. The results of the study indicated that pre-service middle school mathematics teachers are successful in evaluating discussions in the cases regarding proof by contradiction. In terms of year level, it was found that the percentage of the second year students' correct answers was the lowest in both cases. Moreover, the first year students were the most successful group in the first case, and the third year students were the most successful group in the second case. Nearly half of the students explained their correct answers by referring to proof by contradiction in the first case while the percentage of students who explained their correct answers by mentioning proof by contradiction in the second case was considerably low. When incorrect answers of pre-service middle school mathematics teachers were analyzed, two reasons of their misinterpretations of discussions were emerged as "misunderstanding of the assumption" and "perceiving proof as unnecessary".

Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil.

PubMed

Barbieri, Raquel Rodrigues; Sales, Anna Maria; Hacker, Mariana Andrea; Nery, José Augusto da Costa; Duppre, Nádia Cristina; Machado, Alice de Miranda; Moraes, Milton Ozório; Sarno, Euzenir Nunes

2016-10-01

We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

Mixed Sequence Reader: A Program for Analyzing DNA Sequences with Heterozygous Base Calling

PubMed Central

Chang, Chun-Tien; Tsai, Chi-Neu; Tang, Chuan Yi; Chen, Chun-Houh; Lian, Jang-Hau; Hu, Chi-Yu; Tsai, Chia-Lung; Chao, Angel; Lai, Chyong-Huey; Wang, Tzu-Hao; Lee, Yun-Shien

2012-01-01

The direct sequencing of PCR products generates heterozygous base-calling fluorescence chromatograms that are useful for identifying single-nucleotide polymorphisms (SNPs), insertion-deletions (indels), short tandem repeats (STRs), and paralogous genes. Indels and STRs can be easily detected using the currently available Indelligent or ShiftDetector programs, which do not search reference sequences. However, the detection of other genomic variants remains a challenge due to the lack of appropriate tools for heterozygous base-calling fluorescence chromatogram data analysis. In this study, we developed a free web-based program, Mixed Sequence Reader (MSR), which can directly analyze heterozygous base-calling fluorescence chromatogram data in .abi file format using comparisons with reference sequences. The heterozygous sequences are identified as two distinct sequences and aligned with reference sequences. Our results showed that MSR may be used to (i) physically locate indel and STR sequences and determine STR copy number by searching NCBI reference sequences; (ii) predict combinations of microsatellite patterns using the Federal Bureau of Investigation Combined DNA Index System (CODIS); (iii) determine human papilloma virus (HPV) genotypes by searching current viral databases in cases of double infections; (iv) estimate the copy number of paralogous genes, such as β-defensin 4 (DEFB4) and its paralog HSPDP3. PMID:22778697

Enteric Disease Surveillance Under the AFHSC-GEIS: Current Efforts, Landscape Analysis and Vision Forward

DTIC Science & Technology

2011-01-01

Severe diarrhea study at Cairo University • Case-control study of modifiable risk behaviors • Molecular biology and cholera/ rotavirus microbiology...capacity as WHO Rotavirus Reference Laboratory • Norovirus outbreak response support, Incirlik Air Base, Turkey NMRCD-Peru • Cohort study among basic...identified rotavirus as the leading causative agent • Advanced characterization of Campylobacter spp. and Shigella spp. USAMRU-K • Movement of Enteric

Annual Energy Outlook 2016 With Projections to 2040

DOE Office of Scientific and Technical Information (OSTI.GOV)

None, None

The Annual Energy Outlook 2016 (AEO2016), prepared by the U.S. Energy Information Administration (EIA), presents long-term projections of energy supply, demand, and prices through 2040. The projections, focused on U.S. energy markets, are based on results from EIA’s National Energy Modeling System (NEMS). NEMS enables EIA to make projections under alternative, internallyconsistent sets of assumptions. The analysis in AEO2016 focuses on the Reference case and 17 alternative cases. EIA published an Early Release version of the AEO2016 Reference case (including U.S. Environmental Protection Agency’s (EPA) Clean Power Plan (CPP)) and a No CPP case (excluding the CPP) in May 2016.

A 'Global Reference' Comparator for Biosimilar Development.

PubMed

Webster, Christopher J; Woollett, Gillian R

2017-08-01

Major drug regulators have indicated in guidance their flexibility to accept some development data for biosimilars generated with reference product versions licensed outside their own jurisdictions, but most authorities require new bridging studies between these versions and the versions of them licensed locally. The costs of these studies are not trivial in absolute terms and, due to the multiplier effect of required repetition by each biosimilar sponsor, their collective costs are substantial. Yet versions of biologics licensed in different jurisdictions usually share the same development data, and any manufacturing changes between versions have been justified by a rigorous comparability process. The fact that a biosimilar is usually expected to be licensed in multiple jurisdictions, in each case as similar to the local reference product, confirms that minor analytical differences between versions of reference biologics are typically inconsequential for clinical outcomes and licensing. A greatly simplified basis for selecting a reference comparator, that does not require conducting new bridging studies, is proposed and justified based on the shared data of the reference product versions as well as the proof offered where biosimilars have already been approved. The relevance of this proposal to the interchangeability designation available in the US is discussed.

Significance of metabolites in bioequivalence: losartan potassium as a case study.

PubMed

Charoo, Naseem Ahmad; Cristofoletti, Rodrigo; Khatri, Aamer Roshanali; Ali, Areeg Anwer

2014-06-01

Estimation of metabolite data as a supportive evidence of comparable therapeutic outcome is recommended by various guidance documents. However, a consensus on using it solely to establish bioequivalence (BE) is lacking as parent drug is believed to detect pharmacokinetic differences between test and reference formulations better. Four BE studies of losartan potassium reported in the literature are reviewed. In all the four studies, 90% confidence intervals (CIs) of geometric mean ratios of the test and reference formulations for maximum blood drug concentration (Cmax ) of losartan potassium were outside the acceptable range of 80%-125%, whereas, 90% CIs for its active metabolite, losartan carboxylic acid (LCA), were within the acceptance criteria. Although BE with respect to area under the plasma concentration versus time profile curve was demonstrated in all the cases, BE with respect to Cmax could not be established. However, marketing authorization in all the four cases was granted based on scientific evidence that LCA is 10-40 times more potent than losartan, LCA exhibited higher plasma concentration levels than losartan, pharmacodynamic effects correlate with LCA, and losartan shows wide therapeutic index. Further, widened CI limits for losartan were accepted. Losartan presents an opportunity in the diligence of the principles of quality risk management for selecting moiety on which BE decision must be based. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Occurrence of Multiple Sclerosis After Drug Exposure: Insights From Evidence Mapping.

PubMed

Antonazzo, Ippazio Cosimo; Raschi, Emanuel; Vignatelli, Luca; Baldin, Elisa; Riise, Trond; D'Alessandro, Roberto; De Ponti, Fabrizio; Poluzzi, Elisabetta

2017-09-01

The role of drugs in the occurrence of multiple sclerosis (MS) is perceived to be insufficiently investigated. The aim of this study was to map and assess the evidence on MS occurrence after drug exposure, in order to identify possible signals of causal association. A search strategy was performed in MEDLINE and Embase as of July 2016; references consistent with the aim of the study were analysed to extract relevant measures of causal association between drugs and MS. The Newcastle-Ottawa Scale and appropriate guidelines from the International Society for Pharmacoepidemiology (ISPE) and the International Society of Pharmacovigilance (ISoP) were used to assess the quality of included studies. After screening 832 articles, 58 were selected (of which 14 were found by checking the reference lists of reviews): 30 case reports and case series, 24 longitudinal studies and four randomized controlled trials. Seven longitudinal studies had good (at least 7 out of 9) quality scores, whereas case reports/case series presented several limitations. Half of included articles focused on immunomodulatory drugs (etanercept, infliximab and adalimumab), especially in case reports/series, suggesting an association with MS occurrence. Contraceptives and antibacterials were investigated in some population-based studies, without definite results. A heterogeneous pharmacological profile of identified classes emerged. Low strength of evidence and conflicting results highlighted the difficulties in addressing the possible contribution of drugs in MS occurrence. Methodological advances are needed, especially to control the confounding role of underlying disease for specific drug classes.

Gestational diabetes insipidus: a morphological study of the placenta.

PubMed

Castiglione, F; Buccoliero, A M; Garbini, F; Gheri, C F; Moncini, D; Poggi, G; Saladino, V; Rossi Degl'Innocenti, D; Gheri, R G; Taddei, G L

2009-12-01

Gestational diabetes insipidus (GDI) refers to the state of excessive water intake and hypotonic polyuria. Those cases manifesting in pregnancy and referred to as GDI may persist thereafter or may be a transient latent form that resolves after delivery. Microscopic examination of affected subjects has not been previously reported. In the literature, there are various case reports and case series on diabetes insipidus in pregnancy. In this study, we present a case that had transient diabetes insipidus during pregnancy in which the placenta was examined.

Test Guide for ADS-33E-PRF

DTIC Science & Technology

2008-07-01

8501A (Reference 2), and from the V/STOL specification MIL-F-83300 (Reference 3). ADS-33E-PRF contains intermeshed requirements on not only shoi -t- and...While final verification will in most cases require flight testing, initial checks can be performed through analysis and on ground-based simulators...they are difficult to test, or for some reason are deficient in one or more areas. In such cases one or more alternate criteria are presented where

Equivalence testing using existing reference data: An example with genetically modified and conventional crops in animal feeding studies.

PubMed

van der Voet, Hilko; Goedhart, Paul W; Schmidt, Kerstin

2017-11-01

An equivalence testing method is described to assess the safety of regulated products using relevant data obtained in historical studies with assumedly safe reference products. The method is illustrated using data from a series of animal feeding studies with genetically modified and reference maize varieties. Several criteria for quantifying equivalence are discussed, and study-corrected distribution-wise equivalence is selected as being appropriate for the example case study. An equivalence test is proposed based on a high probability of declaring equivalence in a simplified situation, where there is no between-group variation, where the historical and current studies have the same residual variance, and where the current study is assumed to have a sample size as set by a regulator. The method makes use of generalized fiducial inference methods to integrate uncertainties from both the historical and the current data. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

What kinds of cases do paediatricians refer to clinical ethics? Insights from 184 case referrals at an Australian paediatric hospital.

PubMed

McDougall, Rosalind J; Notini, Lauren

2016-09-01

Clinical ethics has been developing in paediatric healthcare for several decades. However, information about how paediatricians use clinical ethics case consultation services is extremely limited. In this project, we analysed a large set of case records from the clinical ethics service of one paediatric hospital in Australia. We applied a paediatric-specific typology to the case referrals, based on the triadic doctor-patient-parent relationship. We reviewed the 184 cases referred to the service in the period 2005-2014, noting features including the type of case, the referring department(s) and the patient's age at referral. The two most common types of referral involved clinician uncertainty about the appropriate care pathway for the child (26% of total referrals) and situations where the child's parents disagreed with the doctors' recommendations for the child's care (22% of total referrals). Referrals came from 28 different departments. Cancer, cardiology/cardiac surgery and general medicine referred the highest numbers of cases. The most common patient age groups were children under 1, and 14-15 years old. For three controversial areas of paediatric healthcare, clinicians had initiated processes of routine review of cases by the clinical ethics service. These insights into the way in which one very active paediatric clinical ethics service is used further our understanding of the work of paediatric clinical ethics, particularly the kinds of ethically challenging cases that paediatricians view as appropriate to refer for clinical ethics support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Tie that Binds: Building Discourse Communities and Group Cohesion through Computer-Based Conferences.

ERIC Educational Resources Information Center

Selfe, Cynthia L.; Eilola, J. Daniel

1988-01-01

Discussion of the use of electronic conferencing to form a discourse community focuses on a case study of student consultants working in a microcomputer lab supporting writing courses at Michigan Technological University. The formulation of a group identity, as well as group values, goals, and expectations are discussed. (16 references) (LRW)

"It's Harder Than We Thought It Would Be": A Comparative Case Study of Expert-Novice Experimentation Strategies.

ERIC Educational Resources Information Center

Hmelo-Silver, Cindy E.; Nagarajan, Anandi; Day, Roger S.

2002-01-01

Compares a group of expert cancer researchers with four groups of fourth year medical students (the "novice" groups) engaged in the task of designing a clinical trial to test a new cancer drug using a computer-based modeling tool, the Oncology Thinking Cap. (Contains 24 references.) (Author/YDS)

Localisation, Globalisation and SMEs in European Tourism: The "Virtual Enterprise" Model of Intervention.

ERIC Educational Resources Information Center

Davenport, Elisabeth

2000-01-01

Discussion of the effect of globalization on SMEs (small and medium enterprises) in Europe focuses on a case study of a current European Commission (EC) project, Net Quality, which is based on the virtual enterprise as an intervention model that may encourage small businesses to cooperate in strategic ventures. (Contains 29 references.)…

Lexicogrammar in the International Construction Industry: A Corpus-Based Case Study of Japanese-Hong-Kongese On-Site Interactions in English

ERIC Educational Resources Information Center

Handford, Michael; Matous, Petr

2011-01-01

The purpose of this research is to identify and interpret statistically significant lexicogrammatical items that are used in on-site spoken communication in the international construction industry, initially through comparisons with reference corpora of everyday spoken and business language. Several data sources, including audio and video…

In the Midst of a Shift: Undergraduate STEM Education and "PBL" Enactment

ERIC Educational Resources Information Center

Wallace, Maria F. G.; Webb, Angela W.

2016-01-01

In the engineering field, problem- and project-based learning, both of which are often referred to as PBL, are the dominant instructional models called for by accreditation agencies. The aim of this qualitative case study is to analyze and capture a holistic perspective of PBL course design and its implementation in two communication-intensive…

Intimate Partner Violence among Pregnant and Parenting Latina Adolescents

ERIC Educational Resources Information Center

Newman, Bernie Sue; Campbell, Caroline

2011-01-01

The purpose of this study was to examine the nature and extent of mutual violence among a sample of pregnant and parenting Latina adolescent females and their partners. The sample consisted of 73 Latina adolescent females between the ages of 14 and 20 who were referred to a community-based organization for case management, education, and…

Risks of hospitalization and drug consumption in children and young adults with diagnosed celiac disease and the role of maternal education: a population-based matched birth cohort study.

PubMed

Canova, Cristina; Pitter, Gisella; Ludvigsson, Jonas F; Romor, Pierantonio; Zanier, Loris; Zanotti, Renzo; Simonato, Lorenzo

2016-01-05

Celiac disease (CD) may affect healthcare use in children and young adults. Socio-economic factors may act as a confounder or effect modifier. We assessed such hypotheses in a population-based birth cohort of young celiac subjects and references matched by maternal education. The cohort included all newborns recorded in the Medical Birth Register of Friuli-Venezia Giulia Region (Italy) between 1989 and 2011. CD incident cases were identified through pathology reports, hospital discharges and copayment exemptions and matched with up to five references by sex, year of birth and maternal education. Cox regression models were used to estimate Hazard Ratios (HRs) for major causes of inpatient diagnosis and drug prescription occurring after diagnosis in CD patients compared to references, stratifying by time of first event and maternal education. We identified 1294 CD cases and 5681 references. CD cases had a higher risk of hospital admission for any cause (HR: 2.34; 95 % CI 2.08-2.63) and for all major ICD9-CM categories except obstetric complications, skin and musculoskeletal diseases, and injuries and poisoning. Prescription of all major ATC drug categories, except dermatologicals and genito-urinary medications, was significantly increased in CD subjects. For most outcomes, HRs were highest in the first year after CD diagnosis but remained significant after five or more years. HRs were similar across different categories of maternal education. Diagnosed CD subjects had a higher risk of hospitalization and medication use compared to the general population, even five or more years after diagnosis, with no effect modification of maternal education.

Benefits of Integration of Aerojet Rocketdyne and RTI Advanced Gasification Technologies for Hydrogen-Rich Syngas Production

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gupta, Vijay; Denton, David; SHarma, Pradeep

The key objective for this project was to evaluate the potential to achieve substantial reductions in the production cost of H 2-rich syngas via coal gasification with near-zero emissions due to the cumulative and synergistic benefits realized when multiple advanced technologies are integrated into the overall conversion process. In this project, Aerojet Rocketdyne’s (AR’s) advanced gasification technology (currently being offered as R-GAS™) and RTI International’s (RTI’s) advanced warm syngas cleanup technologies were evaluated via a number of comparative techno-economic case studies. AR’s advanced gasification technology consists of a dry solids pump and a compact gasifier system. Based on the uniquemore » design of this gasifier, it has been shown to reduce the capital cost of the gasification block by between 40 and 50%. At the start of this project, actual experimental work had been demonstrated through pilot plant systems for both the gasifier and dry solids pump. RTI’s advanced warm syngas cleanup technologies consist primarily of RTI’s Warm Gas Desulfurization Process (WDP) technology, which effectively allows decoupling of the sulfur and CO 2 removal allowing for more flexibility in the selection of the CO 2 removal technology, plus associated advanced technologies for direct sulfur recovery and water gas shift (WGS). WDP has been demonstrated at pre-commercial scale using an activated amine carbon dioxide recovery process which would not have been possible if a majority of the sulfur had not been removed from the syngas by WDP. This pre-commercial demonstration of RTI’s advanced warm syngas cleanup system was conducted in parallel to the activities on this project. The technical data and cost information from this pre-commercial demonstration were extensively used in this project during the techno-economic analysis. With this project, both of RTI’s advanced WGS technologies were investigated. Because RT’s advanced fixed-bed WGS (AFWGS) process was successfully implemented in the WDP pre-commercial demonstration test mentioned above, this technology was used as part of RTI’s advanced warm syngas technology package for the techno-economic analyses for this project. RTI’s advanced transport-reactor-based WGS (ATWGS) process was still conceptual at the start of this project, but one of the tasks for this project was to evaluate the technical feasibility of this technology. In each of the three application-based comparison studies conducted as part of this project, the reference case was based on an existing Department of Energy National Energy Technology Laboratory (DOE/NETL) system study. Each of these references cases used existing commercial technology and the system resulted in > 90% carbon capture. In the comparison studies for the use of the hydrogen-rich syngas generated in either an Integrated Gasification Combined Cycle (IGCC) or a Coal-to-Methanol (CTM) plant, the comparison cases consisted of the reference case, a case with the integration of each individual advanced technology (either AR or RTI), and finally a case with the integration of all the advanced technologies (AR and RTI combined). In the Coal-to-Liquids (CTL) comparison study, the comparison study consisted of only three cases, which included a reference case, a case with just RTI’s advanced syngas cleaning technology, and a case with AR’s and RTI’s advanced technologies. The results from these comparison studies showed that the integration of the advanced technologies did result in substantial benefits, and by far the greatest benefits were achieved for cases integrating all the advanced technologies. For the IGCC study, the fully integrated case resulted in a 1.4% net efficiency improvement, an 18% reduction in capital cost per kW of capacity, a 12% reduction in the operating cost per kWh, and a 75–79% reduction in sulfur emissions. For the CTM case, the fully integrated plant resulted in a 22% reduction in capital cost, a 13% reduction in operating costs, a > 99% net reduction in sulfur emissions, and a reduction of 13–15% in CO 2 emissions. Because the capital cost represents over 60% of the methanol Required Selling Price (RSP), the significant reduction in the capital cost for the advanced technology case resulted in an 18% reduction in methanol RSP. For the CTL case, the fully integrated plant resulted in a 16% reduction in capital cost, which represented a 13% reduction in diesel RSP. Finally, the technical feasibility analysis of RTI’s ATWGS process demonstrated that a fluid-bed catalyst with sufficient attrition resistance and WGS activity could be made and that the process achieved about a 24% reduction in capital cost compared to a conventional fixed-bed commercial process.« less

Chronic lymphatic leukaemia and engine exhausts, fresh wood, and DDT: a case-referent study.

PubMed Central

Flodin, U; Fredriksson, M; Persson, B; Axelson, O

1988-01-01

The effect of potential risk factors for chronic lymphatic leukaemia was evaluated in a case-referent study encompassing 111 cases and 431 randomised referents, all alive. Information on exposure was obtained by questionnaires posted to the subjects. Crude rate ratios were increased for occupational exposure to solvents. DDT, engine exhausts, fresh wood (lumberjacks, paper pulp workers, and sawmill workers, for example) and also in farming. Further analysis of the material by means of the Miettinen confounder score technique reduced the number of rate ratios significantly exceeding unity to encompass only occupational exposure to engine exhaust, fresh wood, DDT, and contact with horses. PMID:2449239

ED-WAVE tool design approach: Case of a textile wastewater treatment plant in Blantyre, Malawi

NASA Astrophysics Data System (ADS)

Chipofya, V.; Kraslawski, A.; Avramenko, Y.

The ED-WAVE tool is a PC based package for imparting training on wastewater treatment technologies. The system consists of four modules viz. Reference Library, Process Builder, Case Study Manager, and Treatment Adviser. The principles of case-based design and case-based reasoning as applied in the ED-WAVE tool are utilised in this paper to evaluate the design approach of the wastewater treatment plant at Mapeto David Whitehead & Sons (MDW&S) textile and garments factory, Blantyre, Malawi. The case being compared with MDW&S in the ED-WAVE tool is Textile Case 4 in Sri Lanka (2003). Equalisation, coagulation and rotating biological contactors is the sequencing of treatment units at Textile Case 4 in Sri Lanka. Screening, oxidation ditches and sedimentation is the sequencing of treatment units at MDW&S textile and garments factory. The study suggests that aerobic biological treatment is necessary in the treatment of wastewater from a textile and garments factory. MDW&S incorporates a sedimentation process which is necessary for the removal of settleable matter before the effluent is discharged to the municipal wastewater treatment plant. The study confirmed the practical use of the ED-WAVE tool in the design of wastewater treatment systems, where after encountering a new situation; already collected decision scenarios (cases) are invoked and modified in order to arrive at a particular design alternative. What is necessary, however, is to appropriately modify the case arrived at through the Case Study Manager in order to come up with a design appropriate to the local situation taking into account technical, socio-economic and environmental aspects.

Australasian haematologist referral patterns to palliative care: lack of consensus on when and why.

PubMed

Auret, K; Bulsara, C; Joske, D

2003-12-01

Patients with haematological malignancies are not referred to palliative care services as frequently as those with solid cancers (non-haematological malignancies). The present study surveyed haematologists in Australia and New Zealand. We aimed to record theoretical referral times, identify problems with referral to palliative care and clarify elements used to decide whether a patient was "terminally ill". A questionnaire based on the case-histories of three patients (with acute leukaemia, lymphoma or multiple myeloma) was distributed at the Haematology Society of Australia and New Zealand Congress 2000, Perth, Australia. Each case was divided into stages by transitional points in the illness to include issues or prognostic variables that may stimulate referral to palliative care. Questions were asked about: (i) referral-triggers, (ii) problems previously experienced, (iii) definition of when the patient was "terminally ill", (iv) prognostication difficulties and (v) communication about prognosis. The response rate was 11%, which may represent up to 32% of Australian specialists. Eighty per cent had access to all types of palliative care services and refer for symptom control, regardless of illness stage. Twenty-nine per cent had experienced difficulties in referring. There was a variation as to exactly when referral would occur and when each case was considered "terminally ill". Reasons for early or later referral were explored. Prognostication difficulties were common. In theory there is a willingness to refer to palliative care, however this has yet to be translated to day-to-day practice. This may be due to prognostication difficulties, logistical factors and medical concerns. Models of referral are suggested for further study.

The accuracy of prehospital diagnosis of acute cerebrovascular accidents: an observational study.

PubMed

Karliński, Michał; Gluszkiewicz, Marcin; Członkowska, Anna

2015-06-19

Time to treatment is the key factor in stroke care. Although the initial medical assessment is usually made by a non-neurologist or a paramedic, it should ensure correct identification of all acute cerebrovascular accidents (CVAs). Our aim was to evaluate the accuracy of the physician-made prehospital diagnosis of acute CVA in patients referred directly to the neurological emergency department (ED), and to identify conditions mimicking CVAs. This observational study included consecutive patients referred to our neurological ED by emergency physicians with a suspicion of CVA (acute stroke, transient ischemic attack (TIA) or a syndrome-based diagnosis) during 12 months. Referrals were considered correct if the prehospital diagnosis of CVA proved to be stroke or TIA. The prehospital diagnosis of CVA was correct in 360 of 570 cases. Its positive predictive value ranged from 100% for the syndrome-based diagnosis, through 70% for stroke, to 34% for TIA. Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p < 0.001). The most frequent mimics were vertigo (19%), electrolyte and metabolic disturbances (12%), seizures (11%), cardiovascular disorders (10%), blood hypertension (8%) and brain tumors (5%). Additionally, 6% of all admitted CVA cases were referred with prehospital diagnoses other than CVA. Emergency physicians appear to be sensitive in diagnosing CVAs but their overall accuracy does not seem high. They tend to overuse the diagnosis of TIA. Constant education and adoption of stroke screening scales may be beneficial for emergency care systems based both on physicians and on paramedics.

The accuracy of prehospital diagnosis of acute cerebrovascular accidents: an observational study

PubMed Central

Gluszkiewicz, Marcin; Członkowska, Anna

2015-01-01

Introduction Time to treatment is the key factor in stroke care. Although the initial medical assessment is usually made by a non-neurologist or a paramedic, it should ensure correct identification of all acute cerebrovascular accidents (CVAs). Our aim was to evaluate the accuracy of the physician-made prehospital diagnosis of acute CVA in patients referred directly to the neurological emergency department (ED), and to identify conditions mimicking CVAs. Material and methods This observational study included consecutive patients referred to our neurological ED by emergency physicians with a suspicion of CVA (acute stroke, transient ischemic attack (TIA) or a syndrome-based diagnosis) during 12 months. Referrals were considered correct if the prehospital diagnosis of CVA proved to be stroke or TIA. Results The prehospital diagnosis of CVA was correct in 360 of 570 cases. Its positive predictive value ranged from 100% for the syndrome-based diagnosis, through 70% for stroke, to 34% for TIA. Misdiagnoses were less frequent among ambulance physicians compared to primary care and outpatient physicians (33% vs. 52%, p < 0.001). The most frequent mimics were vertigo (19%), electrolyte and metabolic disturbances (12%), seizures (11%), cardiovascular disorders (10%), blood hypertension (8%) and brain tumors (5%). Additionally, 6% of all admitted CVA cases were referred with prehospital diagnoses other than CVA. Conclusions Emergency physicians appear to be sensitive in diagnosing CVAs but their overall accuracy does not seem high. They tend to overuse the diagnosis of TIA. Constant education and adoption of stroke screening scales may be beneficial for emergency care systems based both on physicians and on paramedics. PMID:26170845

Feasibility, safety and cost of outpatient management of acute minor ischaemic stroke: a population-based study.

PubMed

Paul, Nicola L M; Koton, Silvia; Simoni, Michela; Geraghty, Olivia C; Luengo-Fernandez, Ramon; Rothwell, Peter M

2013-03-01

Outpatient management safely and effectively prevents early recurrent stroke after transient ischaemic attack (TIA), but this approach may not be safe in patients with acute minor stroke. To study outcomes of clinic and hospital-referred patients with TIA or minor stroke (National Institute of Health Stroke Scale score ≤3) in a prospective, population-based study (Oxford Vascular Study). Of 845 patients with TIA/stroke, 587 (69%) were referred directly to outpatient clinics and 258 (31%) directly to inpatient services. Of the 250 clinic-referred minor strokes (mean age 72.7 years), 237 (95%) were investigated, treated and discharged on the same day, of whom 16 (6.8%) were subsequently admitted to hospital within 30 days for recurrent stroke (n=6), sepsis (n=3), falls (n=3), bleeding (n=2), angina (n=1) and nursing care (n=1). The 150 patients (mean age 74.8 years) with minor stroke referred directly to hospital (median length-of-stay 9 days) had a similar 30-day readmission rate (9/150; 6.3%; p=0.83) after initial discharge and a similar 30-day risk of recurrent stroke (9/237 in clinic patients vs 8/150, OR=0.70, 0.27-1.80, p=0.61). Rates of prescription of secondary prevention medication after initial clinic/hospital discharge were higher in clinic-referred than in hospital-referred patients for antiplatelets/anticoagulants (p<0.05) and lipid-lowering agents (p<0.001) and were maintained at 1-year follow-up. The mean (SD) secondary care cost was £8323 (13 133) for hospital-referred minor stroke versus £743 (1794) for clinic-referred cases. Outpatient management of clinic-referred minor stroke is feasible and may be as safe as inpatient care. Rates of early hospital admission and recurrent stroke were low and uptake and maintenance of secondary prevention was high.

A Descriptive Case Study of the Ethics of Care Fostered by a Statewide Blended Teaching Model in Support of Site-Based Exceptional Children Teachers

ERIC Educational Resources Information Center

Cadran, Amanda

2016-01-01

The term Exceptional Children refers to both the highest performing students in the most advanced classes as well as those with the most severe intellectual challenges and every level of functioning in between. In one southeastern state, Exceptional Children teachers work with high school Occupational Course of Study students. These students, who…

Cross-sectional study of the association of abomasal displacement or volvulus with serum electrolyte and mineral concentrations in dairy cows.

PubMed Central

Delgado-Lecaroz, R; Warnick, L D; Guard, C L; Smith, M C; Barry, D A

2000-01-01

The objective of this study was to evaluate serum mineral and electrolyte concentrations at the time of on-farm diagnosis of left displaced abomasum, right displaced abomasum, or abomasal volvulus in dairy cows. Data were collected from 104 affected cows and 96 control cows matched with cases, based on herd, parity, and stage of lactation. Cows with abomasal displacement or volvulus had significantly lower calcium, phosphorous, magnesium, potassium, and chloride concentrations and increased anion gap at the time of diagnosis compared with control cows from the same herds. The percentages of cases and controls with total serum calcium concentrations below the lower limit of the laboratory reference range (2.08 mmol/L [8.3 mg/dL]) were 70% and 23%, respectively. Based on the large percentage of cases with hypocalcemia, administering calcium salts at the time of treatment of field cases of abomasal displacement or volvulus may be beneficial. PMID:10769767

A multicenter study on PIVKA reference interval of healthy population and establishment of PIVKA cutoff value for hepatocellular carcinoma diagnosis in China.

PubMed

Qin, X; Tang, G; Gao, R; Guo, Z; Liu, Z; Yu, S; Chen, M; Tao, Z; Li, S; Liu, M; Wang, L; Hou, L; Xia, L; Cheng, X; Han, J; Qiu, L

2017-08-01

The aim of this study was to investigate the reference interval of protein-induced vitamin K absence or antagonist-II (PIVKA-II) in China population and to evaluate its medical decision level for hepatocellular carcinoma (HCC) diagnosis. To determine the reference range for Chinese individuals, a total of 855 healthy subjects in five typical regions of China were enrolled in this study to obtain a 95% reference interval. In a case-control study which recruited the subjects diagnosed with HCC, metastatic liver cancer, bile duct cancer, hepatitis, cirrhosis, other benign liver diseases and the subjects administrated anticoagulant, receiver operating characteristic analysis was used to determine PIVKA-II cutoff value for a medical decision. The concentration of PIVKA-II had no relationship with age or gender and that region was a significant factor associated with the level of PIVKA-II. The 95% reference interval determined in this study for PIVKA-II in Chinese healthy individuals was 28 mAU/mL, and the cutoff value which to distinguish patients with HCC from disease control groups is 36.5 mAU/mL. In clinical applications, it is recommended that each laboratory chooses their own reference interval based on the regional population study or cutoff value for disease diagnosis. © 2017 John Wiley & Sons Ltd.

Epidemiology of tinea capitis in northeast Iran: a retrospective analysis from 1998 to 2012.

PubMed

Afshar, Parvaneh; Vahedi, Lale; Ghasemi, Maryam; Mardanshahi, Alireza

2016-06-01

Tinea capitis is a common disease of the pediatric population. This disease typically follows one of several clinical patterns, i.e., scaling, hair loss, and/or inflammatory lesions, which are usually caused predominantly by two dermatophytic genera: Microsporum and Trichophyton. The aim of this study was to investigate tinea capitis and its etiological agents in Sari city of Mazandaran province, Iran. We studied the spectrum of tinea capitis by means of a retrospective analysis involving 1745 patients referred to both the Reference Laboratory of Medical Mycology (RLMM) and Bo Ali Sina Hospital at Sari, Iran (1998-2012). Specimens were assessed by standard mycological techniques based on macroscopic and microscopic morphology. Among the patients, 480 (27.5%; 61 males and 39% females) were confirmed through a mycological examination. The peak incidence was in the 5-14 years age group. Endothrix (263 cases; 54.8%) was the most frequent clinical feature by direct exam. The predominant causative agents of tinea capitis were T. tonsurans (186 cases; 38.8%) and T. violaceum (119 cases; 24.8%), followed by T. mentagrophytes (46 cases; 9.6%), T. schoenleinii (28; 5.8%), T. rubrum (20 cases; 4.2%), M. gypseum (15 cases; 3.1%), T. verrucosum (14 cases; 2.9%), and Epidermophyton floccosum (1 cases; 0.2%). The present study showed that tinea capitis is mainly due to the anthropophilic species, and the most common species were T. tonsurans and T. violaceum. Owing to the high frequency of anthropophilic species, future studies may be useful in the development of preventive and educational strategies to reduce healthcare expenditure. © 2015 The International Society of Dermatology.

Performance of Panfungal- and Specific-PCR-Based Procedures for Etiological Diagnosis of Invasive Fungal Diseases on Tissue Biopsy Specimens with Proven Infection: a 7-Year Retrospective Analysis from a Reference Laboratory

PubMed Central

Bernal-Martinez, L.; Castelli, M. V.; Rodriguez-Tudela, J. L.; Cuenca-Estrella, M.

2014-01-01

A retrospective analysis of real-time PCR (RT-PCR) results for 151 biopsy samples obtained from 132 patients with proven invasive fungal diseases was performed. PCR-based techniques proved to be fast and sensitive and enabled definitive diagnosis in all cases studied, with detection of a total of 28 fungal species. PMID:24574295

Using Natural Language Processing to Improve Efficiency of Manual Chart Abstraction in Research: The Case of Breast Cancer Recurrence

PubMed Central

Carrell, David S.; Halgrim, Scott; Tran, Diem-Thy; Buist, Diana S. M.; Chubak, Jessica; Chapman, Wendy W.; Savova, Guergana

2014-01-01

The increasing availability of electronic health records (EHRs) creates opportunities for automated extraction of information from clinical text. We hypothesized that natural language processing (NLP) could substantially reduce the burden of manual abstraction in studies examining outcomes, like cancer recurrence, that are documented in unstructured clinical text, such as progress notes, radiology reports, and pathology reports. We developed an NLP-based system using open-source software to process electronic clinical notes from 1995 to 2012 for women with early-stage incident breast cancers to identify whether and when recurrences were diagnosed. We developed and evaluated the system using clinical notes from 1,472 patients receiving EHR-documented care in an integrated health care system in the Pacific Northwest. A separate study provided the patient-level reference standard for recurrence status and date. The NLP-based system correctly identified 92% of recurrences and estimated diagnosis dates within 30 days for 88% of these. Specificity was 96%. The NLP-based system overlooked 5 of 65 recurrences, 4 because electronic documents were unavailable. The NLP-based system identified 5 other recurrences incorrectly classified as nonrecurrent in the reference standard. If used in similar cohorts, NLP could reduce by 90% the number of EHR charts abstracted to identify confirmed breast cancer recurrence cases at a rate comparable to traditional abstraction. PMID:24488511

Peeling skin diseases: 21 cases from Turkey and a review of the literature.

PubMed

Köse, O; Safali, M; Koç, E; Arca, E; Açikgöz, G; Özmen, I; Yeniay, Y

2012-07-01

Peeling skin diseases (PSD) refer to a group of rare autosomal recessive dermatosis which are characterized by spontaneous, continual peeling of the skin. Three different clinical pictures can be distinguished: Inflammatory PSD also referred to as peeling skin syndrome (PSS) type B, non-inflammatory PSD also referred to as PSS type A, and localized forms i.e. acral type PSS. To characterize the clinical and histopathological features of PSD in Turkey. We retrospectively reviewed the medical records and clinical photographs of patients who were given diagnosis of PSD and conducted histopathological evaluation of skin biopsies to identify the site of cleavage. Also we evaluated the cases including age, gender, age onset, clinical and histological findings, family history, associated disorders and PSD type. Twenty-one patients with PSD were seen at Gulhane School of Medicine in Ankara between the years 1994 and 2010 in this retrospective study. All patients were men. Their ages were between 20 and 26 years (22.44±2.30, Mean age±SD). Of the patients, eight cases (40%) were type A, eight cases (40%) were type B, and five cases (20%) were acral type PSS. Eleven cases (52%) had parental consanguinity. Keratoderma, cheilitis, keratosis pilaris, melanonichia, clubbing, hyperhidrosis, onychodystrophy were observed in eight cases as an accompanying disorder. In this case series, PSD occurred rarely and also showed generally mild course of disease in Turkey and most likely related to consanguineous of marriages. Future investigations on PSD will contribute to our progressing alternative targets for pathogenesis-based therapy. © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.

Designing image segmentation studies: Statistical power, sample size and reference standard quality.

PubMed

Gibson, Eli; Hu, Yipeng; Huisman, Henkjan J; Barratt, Dean C

2017-12-01

Segmentation algorithms are typically evaluated by comparison to an accepted reference standard. The cost of generating accurate reference standards for medical image segmentation can be substantial. Since the study cost and the likelihood of detecting a clinically meaningful difference in accuracy both depend on the size and on the quality of the study reference standard, balancing these trade-offs supports the efficient use of research resources. In this work, we derive a statistical power calculation that enables researchers to estimate the appropriate sample size to detect clinically meaningful differences in segmentation accuracy (i.e. the proportion of voxels matching the reference standard) between two algorithms. Furthermore, we derive a formula to relate reference standard errors to their effect on the sample sizes of studies using lower-quality (but potentially more affordable and practically available) reference standards. The accuracy of the derived sample size formula was estimated through Monte Carlo simulation, demonstrating, with 95% confidence, a predicted statistical power within 4% of simulated values across a range of model parameters. This corresponds to sample size errors of less than 4 subjects and errors in the detectable accuracy difference less than 0.6%. The applicability of the formula to real-world data was assessed using bootstrap resampling simulations for pairs of algorithms from the PROMISE12 prostate MR segmentation challenge data set. The model predicted the simulated power for the majority of algorithm pairs within 4% for simulated experiments using a high-quality reference standard and within 6% for simulated experiments using a low-quality reference standard. A case study, also based on the PROMISE12 data, illustrates using the formulae to evaluate whether to use a lower-quality reference standard in a prostate segmentation study. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Familial Aggregation of Amyotrophic Lateral Sclerosis

PubMed Central

Kamel, Freya; Lichtenstein, Paul; Bellocco, Rino; Sparén, Pär; Sandler, Dale P; Ye, Weimin

2009-01-01

Objective To assess the relative risk of amyotrophic lateral sclerosis (ALS) in families of ALS patients. Methods We conducted a cohort study based on the Swedish Multi-Generation Register (MGR) in 1961-2005. Among 6,671 probands (first ALS case in the family), 1,909 full siblings, 13,947 children, and 5,405 spouses were identified (exposed group). Other persons in MGR, who were siblings, children, or spouses to persons without ALS, served as the reference group. Relative risks of ALS among the exposed group, compared to the reference group, were calculated from Poisson regression models. Concurrence of ALS within twins was assessed in 86,441 twin pairs registered in the Swedish Twin Register. Results Nine cases of ALS were noted among the siblings and 37 cases among the children of the probands, giving a 17-fold risk among the siblings (95% confidence interval [CI], 8.1-30.4) and a 9-fold risk among the children (95% CI, 6.2-12.0), compared to the reference group. Siblings and children had a higher excess risk if the proband was diagnosed at younger age, and the excess risks decreased with increasing age at diagnosis of the proband (p < 0.001). Spouses had no significantly increased risk (p = 0.27). Two cases were identified among the co-twins of ALS probands, giving a relative risk of 32 (95% CI, 5.2-102.6). Interpretation The siblings and children of ALS patients have an around 10-fold risk of ALS compared to the reference group. The excess risks vary with both age and kinship, indicating a major genetic role in familial ALS. PMID:19670447

The Learning Outcomes of Mentoring Library Science Students in Virtual World Reference: A Case Study

ERIC Educational Resources Information Center

Purpur, Geraldine; Morris, Jon Levi

2015-01-01

This article reports on the cognitive and affective development of students being mentored in virtual reference interview skills by professional librarians. The authors present a case study which examines the impact on student learning resulting from librarian mentor participation and collaboration with students on a course assignment. This study…

Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.

PubMed Central

Nutbeam, D; Smith, C; Murphy, S; Catford, J

1993-01-01

STUDY OBJECTIVE--To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes. DESIGN--Semistructured interviews of health promotion managers. SETTING--Wales and two reference health regions in England. PARTICIPANTS--Nine health promotion managers in Wales and 18 in England. MEASUREMENTS AND MAIN RESULTS--Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas. CONCLUSION--Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended. PMID:8326270

Application of Bayes' to the prediction of referral decisions made by specialist optometrists in relation to chronic open angle glaucoma.

PubMed

Gurney, J C; Ansari, E; Harle, D; O'Kane, N; Sagar, R V; Dunne, M C M

2018-02-09

To determine the accuracy of a Bayesian learning scheme (Bayes') applied to the prediction of clinical decisions made by specialist optometrists in relation to the referral refinement of chronic open angle glaucoma. This cross-sectional observational study involved collection of data from the worst affected or right eyes of a consecutive sample of cases (n = 1,006) referred into the West Kent Clinical Commissioning Group Community Ophthalmology Team (COT) by high street optometrists. Multilevel classification of each case was based on race, sex, age, family history of chronic open angle glaucoma, reason for referral, Goldmann Applanation Tonometry (intraocular pressure and interocular asymmetry), optic nerve head assessment (vertical size, cup disc ratio and interocular asymmetry), central corneal thickness and visual field analysis (Hodapp-Parrish-Anderson classification). Randomised stratified tenfold cross-validation was applied to determine the accuracy of Bayes' by comparing its output to the clinical decisions of three COT specialist optometrists; namely, the decision to discharge, follow-up or refer each case. Outcomes of cross-validation, expressed as means and standard deviations, showed that the accuracy of Bayes' was high (95%, 2.0%) but that it falsely discharged (3.4%, 1.6%) or referred (3.1%, 1.5%) some cases. The results indicate that Bayes' has the potential to augment the decisions of specialist optometrists.

The Performance Blueprint: An Integrated Logic Model Developed To Enhance Performance Measurement Literacy: The Case of Performance-Based Contract Management.

ERIC Educational Resources Information Center

Longo, Paul J.

This study explored the mechanics of using an enhanced, comprehensive multipurpose logic model, the Performance Blueprint, as a means of building evaluation capacity, referred to in this paper as performance measurement literacy, to facilitate the attainment of both service-delivery oriented and community-oriented outcomes. The application of this…

Use of Validation by Enterprises for Human Resource and Career Development Purposes. Cedefop Reference Series No 96

ERIC Educational Resources Information Center

Cedefop - European Centre for the Development of Vocational Training, 2014

2014-01-01

European enterprises give high priority to assessing skills and competences, seeing this as crucial for recruitment and human resource management. Based on a survey of 400 enterprises, 20 in-depth case studies and interviews with human resource experts in 10 countries, this report analyses the main purposes of competence assessment, the standards…

Risk factors for occupational acute mountain sickness.

PubMed

Vinnikov, D; Brimkulov, N; Krasotski, V; Redding-Jones, R; Blanc, P D

2014-10-01

Studies of occupational acute mountain sickness (AMS) have not focused on the more severe end of the spectrum to date. To examine risk factors associated with the development of occupational AMS severe enough to receive treatment in a compression chamber. A nested case referent study in a cohort of high-altitude (4000 m) mine workers, comparing cases of severe, chamber-treated AMS to matched referents. Using logistic regression, we tested potential risk factors based on premorbid surveillance examinations, including cigarette smoking (current smoking, smoking intensity and exhaled carbon monoxide [CO]). There were 15 cases and 30 controls. In multivariate analysis including age, sex and place of residence, current smoking was associated with increased risk of severe AMS (odds ratio [OR] 10.0; 95% confidence interval [CI] 1.5-67.4), taking into account any prior, less severe AMS event, which was also a potent risk factor (OR 33.3; 95% CI 2.8-390). Smoking intensity (cigarettes per day) and exhaled CO were also statistically significantly associated with severe AMS. Cigarette smoking is a strong, previously under-appreciated risk factor for severe AMS. Because this is a modifiable factor, these findings suggest that workplace-based smoking cessation should be tested as an intervention to prevent such morbidity. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease.

PubMed

Harrison, R J; Wild, J M; Hobley, A J

1988-11-05

Case notes of 1113 consecutive new patients referred to a consultant ophthalmologist at a district general hospital were reviewed to determine the source and efficacy of referrals and the current screening practices of general practitioners and ophthalmic opticians. General practitioners initiated referral in 546 cases (49%) and ophthalmic opticians referral in 439 (39%). Visual loss or visual disturbance was the most important single reason for referral (345 cases; 31%), followed by suspected glaucoma (145 cases; 13%), abnormalities of binocular vision (140; 12.5%), disorders of eyelids or ocular adnexa (127; 11%), and red eye (86; 8%). General practitioners referred many more patients with disorders of the eyelids and adnexa and ophthalmic opticians many more patients with suspected glaucoma. Ophthalmic opticians were far more likely than general practitioners to refer patients with suspected glaucoma correctly. A total of 180 patients (16%) were referred from ocular screening, in 149 cases by ophthalmic opticians and in 10 by general practitioners. Seventy patients had glaucoma or incomplete features of glaucoma, all of them referred by ophthalmic opticians. Of eight diabetic patients referred by ophthalmic opticians, three had asymptomatic disease and in two diabetes was diagnosed as a result of ocular screening. No patient was referred for asymptomatic diabetic retinopathy from screening by general practitioners. Ophthalmic opticians were more likely than general practitioners to diagnose retinopathy requiring photocoagulation. Use of a community based service to screen for glaucoma could save unnecessary consultant outpatient appointments. A similar service could facilitate detection of diabetic retinopathy at a stage when treatment is most effective.

Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease.

PubMed Central

Harrison, R. J.; Wild, J. M.; Hobley, A. J.

1988-01-01

Case notes of 1113 consecutive new patients referred to a consultant ophthalmologist at a district general hospital were reviewed to determine the source and efficacy of referrals and the current screening practices of general practitioners and ophthalmic opticians. General practitioners initiated referral in 546 cases (49%) and ophthalmic opticians referral in 439 (39%). Visual loss or visual disturbance was the most important single reason for referral (345 cases; 31%), followed by suspected glaucoma (145 cases; 13%), abnormalities of binocular vision (140; 12.5%), disorders of eyelids or ocular adnexa (127; 11%), and red eye (86; 8%). General practitioners referred many more patients with disorders of the eyelids and adnexa and ophthalmic opticians many more patients with suspected glaucoma. Ophthalmic opticians were far more likely than general practitioners to refer patients with suspected glaucoma correctly. A total of 180 patients (16%) were referred from ocular screening, in 149 cases by ophthalmic opticians and in 10 by general practitioners. Seventy patients had glaucoma or incomplete features of glaucoma, all of them referred by ophthalmic opticians. Of eight diabetic patients referred by ophthalmic opticians, three had asymptomatic disease and in two diabetes was diagnosed as a result of ocular screening. No patient was referred for asymptomatic diabetic retinopathy from screening by general practitioners. Ophthalmic opticians were more likely than general practitioners to diagnose retinopathy requiring photocoagulation. Use of a community based service to screen for glaucoma could save unnecessary consultant outpatient appointments. A similar service could facilitate detection of diabetic retinopathy at a stage when treatment is most effective. PMID:3144331

[Application and case analysis on the problem-based teaching of Jingluo Shuxue Xue (Science of Meridian and Acupoint) in reference to the team oriented learning method].

PubMed

Ma, Ruijie; Lin, Xianming

2015-12-01

The problem based teaching (PBT) has been the main approach to the training in the universities o the world. Combined with the team oriented learning method, PBT will become the method available to the education in medical universities. In the paper, based on the common questions in teaching Jingluo Shuxue Xue (Science of Meridian and Acupoint), the concepts and characters of PBT and the team oriented learning method were analyzed. The implementation steps of PBT were set up in reference to the team oriented learning method. By quoting the original text in Beiji Qianjin Yaofang (Essential recipes for emergent use worth a thousand gold), the case analysis on "the thirteen devil points" was established with PBT.

Multimodal Counseling of Childhood Encopresis: A Case Example.

ERIC Educational Resources Information Center

Gumaer, Jim

1990-01-01

Provides information regarding childhood disorder of encopresis and presents multimodal therapy techniques for school counselors who cannot successfully refer clients. Presents a case study of a teenage boy suffering from encopresis who was referred for counseling. Suggests specific treatment strategies including behavior modification, nutrition…

Building a semantic web-based metadata repository for facilitating detailed clinical modeling in cancer genome studies.

PubMed

Sharma, Deepak K; Solbrig, Harold R; Tao, Cui; Weng, Chunhua; Chute, Christopher G; Jiang, Guoqian

2017-06-05

Detailed Clinical Models (DCMs) have been regarded as the basis for retaining computable meaning when data are exchanged between heterogeneous computer systems. To better support clinical cancer data capturing and reporting, there is an emerging need to develop informatics solutions for standards-based clinical models in cancer study domains. The objective of the study is to develop and evaluate a cancer genome study metadata management system that serves as a key infrastructure in supporting clinical information modeling in cancer genome study domains. We leveraged a Semantic Web-based metadata repository enhanced with both ISO11179 metadata standard and Clinical Information Modeling Initiative (CIMI) Reference Model. We used the common data elements (CDEs) defined in The Cancer Genome Atlas (TCGA) data dictionary, and extracted the metadata of the CDEs using the NCI Cancer Data Standards Repository (caDSR) CDE dataset rendered in the Resource Description Framework (RDF). The ITEM/ITEM_GROUP pattern defined in the latest CIMI Reference Model is used to represent reusable model elements (mini-Archetypes). We produced a metadata repository with 38 clinical cancer genome study domains, comprising a rich collection of mini-Archetype pattern instances. We performed a case study of the domain "clinical pharmaceutical" in the TCGA data dictionary and demonstrated enriched data elements in the metadata repository are very useful in support of building detailed clinical models. Our informatics approach leveraging Semantic Web technologies provides an effective way to build a CIMI-compliant metadata repository that would facilitate the detailed clinical modeling to support use cases beyond TCGA in clinical cancer study domains.

Adolescents as perpetrators of aggression within the family.

PubMed

Kuay, Hue San; Lee, Sarah; Centifanti, Luna C M; Parnis, Abigail C; Mrozik, Jennifer H; Tiffin, Paul A

2016-01-01

Although family violence perpetrated by juveniles has been acknowledged as a potentially serious form of violence for over 30years, scientific studies have been limited to examining the incidence and form of home violence. The present study examined the prevalence of family aggression as perpetrated by youths; we examined groups drawn from clinic-referred and forensic samples. Two audits of case files were conducted to systematically document aggression perpetrated by referred youths toward their family members. The purpose of the first audit was fourfold: i) to identify the incidence of the perpetration of family aggression among clinical and forensic samples; ii) to identify whether there were any reports of weapon use during aggressive episodes; iii) to identify the target of family aggression (parents or siblings); and iv) to identify the form of aggression perpetrated (verbal or physical). The second audit aimed to replicate the findings and to show that the results were not due to differences in multiple deprivation indices, clinical diagnosis of disruptive behavior disorders, and placement into alternative care. A sampling strategy was designed to audit the case notes of 25 recent forensic Child and Adolescent Mental Health Service (CAMHS) cases and 25 demographically similar clinic-referred CAMHS cases in the first audit; and 35 forensic cases and 35 demographically similar clinic-referred CAMHS cases in the second audit. Using ordinal chi-square, the forensic sample (audit 1=64%; audit 2=82.9%) had greater instances of family violence than the clinical sample (audit 1=32%; audit 2=28.6%). They were more likely to use a weapon (audit 1=69%; audit 2=65.5%) compared to the clinical sample (audit 1 and 2=0%). Examining only the aggressive groups, there was more perpetration of aggression toward parents (audit 1, forensic=92%, clinical=75%; audit 2, forensic=55.17%, clinical=40%) than toward siblings (audit 1, forensic=43%, clinical=50%; audit 2, forensic=27.58%, clinical=30%). Based on these findings, we would urge professionals who work within the child mental health, particularly the forensic area, to systematically collect reports of aggression perpetrated toward family members. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reference Solutions for Benchmark Turbulent Flows in Three Dimensions

NASA Technical Reports Server (NTRS)

Diskin, Boris; Thomas, James L.; Pandya, Mohagna J.; Rumsey, Christopher L.

2016-01-01

A grid convergence study is performed to establish benchmark solutions for turbulent flows in three dimensions (3D) in support of turbulence-model verification campaign at the Turbulence Modeling Resource (TMR) website. The three benchmark cases are subsonic flows around a 3D bump and a hemisphere-cylinder configuration and a supersonic internal flow through a square duct. Reference solutions are computed for Reynolds Averaged Navier Stokes equations with the Spalart-Allmaras turbulence model using a linear eddy-viscosity model for the external flows and a nonlinear eddy-viscosity model based on a quadratic constitutive relation for the internal flow. The study involves three widely-used practical computational fluid dynamics codes developed and supported at NASA Langley Research Center: FUN3D, USM3D, and CFL3D. Reference steady-state solutions computed with these three codes on families of consistently refined grids are presented. Grid-to-grid and code-to-code variations are described in detail.

Guidelines for the public health management of typhoid and paratyphoid in England: practice guidelines from the National Typhoid and Paratyphoid Reference Group.

PubMed

Balasegaram, S; Potter, A L; Grynszpan, D; Barlow, S; Behrens, R H; Lighton, L; Booth, L; Inamdar, L; Neal, K; Nye, K; Lawrence, J; Jones, J; Gray, I; Tolley, D; Lane, C; Adak, B; Cummins, A; Addiman, S

2012-09-01

The Typhoid and Paratyphoid Reference Group (TPRG) was convened by the Health Protection Agency (HPA) and the Chartered Institute of Environmental Health (CIEH) to revise guidelines for public health management of enteric fever. This paper presents the new guidelines for England and their rationale. Methods include literature reviews including grey literature such as audit data and case studies; analysis of enhanced surveillance data from England, Wales and Northern Ireland; review of clearance and screening schedules in use in other non-endemic areas; and expert consensus. The evidence and principles underpinning the new guidance are summarised. Significant changes from previous guidance include: • Algorithms to guide risk assessment and management, based on risk group and travel history; • Outline of investigation of non-travel cases; • Simplified microbiological clearance schedules for cases and contacts; • Targeted co-traveller screening and a "warn and inform" approach for contacts; • Management of convalescent and chronic carriers. The guidelines were launched in February 2012. Feedback has been positive: the guidelines are reported to be clear, systematic, practical and risk-based. An evaluation of the guidelines is outlined and will add to the evidence base. There is potential for simplification and consistency between international guidelines. Copyright © 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Microfinance participation and contraceptive decision-making: results from a national sample of women in Bangladesh.

PubMed

Murshid, N S; Ely, G E

2016-10-01

Our objective was to assess whether microfinance participation affords greater contraceptive decision-making power to women. Population based secondary data analysis. In this cross-sectional study using nationally representative data from the Bangladesh Demographic and Health Survey 2011 we conducted multinomial logistic regression to estimate the odds of contraceptive decision-making by respondents and their husbands based on microfinance participation. Microfinance participation was measured as a dichotomous variable and contraceptive decision-making was conceptualized based on who made decisions about contraceptive use: respondents only; their partners or husbands only; or both. The odds of decision-making by the respondent, with the reference case being joint decision-making, were higher for microfinance participants, but they were not significant. The odds of decision-making by the husband, with the reference case again being joint decision-making, were significantly lower among men who were partnered with women who participated in microfinance (RRR = 0.70, P < 0.01). Microfinance participation by women allowed men to share decision-making power with their wives that resulted in higher odds of joint decision-making. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Laser scanning-based recognition of rotational movements on a deep seated gravitational instability: The Cinque Torri case (North-Eastern Italian Alps)

NASA Astrophysics Data System (ADS)

Viero, Alessia; Teza, Giordano; Massironi, Matteo; Jaboyedoff, Michel; Galgaro, Antonio

2010-10-01

The Cinque Torri group (Cortina d'Ampezzo, Italy) is an articulated system of unstable carbonatic rock monoliths located in a very important tourism area and therefore characterized by a significant risk. The instability phenomena involved represent an example of lateral spreading developed over a larger deep seated gravitational slope deformation (DSGSD) area. After the recent fall of a monolith of more than 10 000 m 3, a scientific study was initiated to monitor the more unstable sectors and to characterize the past movements as a fundamental tool for predicting future movements and hazard assessment. To achieve greater insight on the ongoing lateral spreading process, a method for a quantitative analysis of rotational movements associated with the lateral spreading has been developed, applied and validated. The method is based on: i) detailed geometrical characterization of the area by means of laser scanner techniques; ii) recognition of the discontinuity sets and definition of a reference frame for each set, iii) correlation between the obtained reference frames related to a specific sector and a stable external reference frame, and iv) determination of the 3D rotations in terms of Euler angles to describe the present settlement of the Cinque Torri system with respect to the surrounding stable areas. In this way, significant information on the processes involved in the fragmentation and spreading of a former dolomitic plateau into different rock cliffs has been gained. The method is suitable to be applied to similar case studies.

WEB-BASED DATABASE ON RENEWAL TECHNOLOGIES ...

EPA Pesticide Factsheets

As U.S. utilities continue to shore up their aging infrastructure, renewal needs now represent over 43% of annual expenditures compared to new construction for drinking water distribution and wastewater collection systems (Underground Construction [UC], 2016). An increased understanding of renewal options will ultimately assist drinking water utilities in reducing water loss and help wastewater utilities to address infiltration and inflow issues in a cost-effective manner. It will also help to extend the service lives of both drinking water and wastewater mains. This research effort involved collecting case studies on the use of various trenchless pipeline renewal methods and providing the information in an online searchable database. The overall objective was to further support technology transfer and information sharing regarding emerging and innovative renewal technologies for water and wastewater mains. The result of this research is a Web-based, searchable database that utility personnel can use to obtain technology performance and cost data, as well as case study references. The renewal case studies include: technologies used; the conditions under which the technology was implemented; costs; lessons learned; and utility contact information. The online database also features a data mining tool for automated review of the technologies selected and cost data. Based on a review of the case study results and industry data, several findings are presented on tren

Nationwide population-based cohort study of celiac disease and risk of Ehlers-Danlos syndrome and joint hypermobility syndrome.

PubMed

Laszkowska, Monika; Roy, Abhik; Lebwohl, Benjamin; Green, Peter H R; Sundelin, Heléne E K; Ludvigsson, Jonas F

2016-09-01

Patients with celiac disease (CD) often have articular complaints, and small prior studies suggest an association with Ehlers-Danlos syndrome (EDS)/joint hypermobility syndrome (JHS). This study examines the risks of EDS/JHS in patients with CD. This cohort study compared all individuals in Sweden diagnosed with CD based on small intestinal biopsy between 1969-2008 (n=28,631) to 139,832 matched reference individuals, and to a second reference group undergoing biopsy without having CD (n=16,104). Rates of EDS/JHS were determined based on diagnostic codes in the Swedish Patient Register. Hazard ratios (HRs) for EDS/JHS were estimated through Cox regression. There are 45 and 148 cases of EDS/JHS in patients with CD and reference individuals, respectively. This corresponds to a 49% increased risk of EDS/JHS in CD (95%CI=1.07-2.07). The HR for EDS was 2.43 (95%CI=1.20-4.91) and for JHS 1.34 (95%CI=0.93-1.95). Compared to reference individuals undergoing intestinal biopsy, CD was not a risk factor for EDS/JHS. A stronger association was seen in patients initially diagnosed with EDS/JHS and subsequently diagnosed with CD (odds ratio=2.29; 95%CI=1.21-4.34). Individuals with CD have higher risk of EDS/JHS than the general population, which may be due to surveillance bias or factors intrinsic to celiac development. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Utility assessment of a map-based online geo-collaboration tool.

PubMed

Sidlar, Christopher L; Rinner, Claus

2009-05-01

Spatial group decision-making processes often include both informal and analytical components. Discussions among stakeholders or planning experts are an example of an informal component. When participants discuss spatial planning projects they typically express concerns and comments by pointing to places on a map. The Argumentation Map model provides a conceptual basis for collaborative tools that enable explicit linkages of arguments to the places to which they refer. These tools allow for the input of explicitly geo-referenced arguments as well as the visual access to arguments through a map interface. In this paper, we will review previous utility studies in geo-collaboration and evaluate a case study of a Web-based Argumentation Map application. The case study was conducted in the summer of 2005 when student participants discussed planning issues on the University of Toronto St. George campus. During a one-week unmoderated discussion phase, 11 participants wrote 60 comments on issues such as safety, facilities, parking, and building aesthetics. By measuring the participants' use of geographic references, we draw conclusions on how well the software tool supported the potential of the underlying concept. This research aims to contribute to a scientific approach to geo-collaboration in which the engineering of novel spatial decision support methods is complemented by a critical assessment of their utility in controlled, realistic experiments.

Towards a Framework for Developing Semantic Relatedness Reference Standards

PubMed Central

Pakhomov, Serguei V.S.; Pedersen, Ted; McInnes, Bridget; Melton, Genevieve B.; Ruggieri, Alexander; Chute, Christopher G.

2010-01-01

Our objective is to develop a framework for creating reference standards for functional testing of computerized measures of semantic relatedness. Currently, research on computerized approaches to semantic relatedness between biomedical concepts relies on reference standards created for specific purposes using a variety of methods for their analysis. In most cases, these reference standards are not publicly available and the published information provided in manuscripts that evaluate computerized semantic relatedness measurement approaches is not sufficient to reproduce the results. Our proposed framework is based on the experiences of medical informatics and computational linguistics communities and addresses practical and theoretical issues with creating reference standards for semantic relatedness. We demonstrate the use of the framework on a pilot set of 101 medical term pairs rated for semantic relatedness by 13 medical coding experts. While the reliability of this particular reference standard is in the “moderate” range; we show that using clustering and factor analyses offers a data-driven approach to finding systematic differences among raters and identifying groups of potential outliers. We test two ontology-based measures of relatedness and provide both the reference standard containing individual ratings and the R program used to analyze the ratings as open-source. Currently, these resources are intended to be used to reproduce and compare results of studies involving computerized measures of semantic relatedness. Our framework may be extended to the development of reference standards in other research areas in medical informatics including automatic classification, information retrieval from medical records and vocabulary/ontology development. PMID:21044697

Review Article: Structural flood-protection measures referring to several European case studies

NASA Astrophysics Data System (ADS)

Kryžanowski, A.; Brilly, M.; Rusjan, S.; Schnabl, S.

2014-01-01

The paper presents a review of structural measures that were taken to cope with floods in some cities along the Danube River, such as Vienna, Bratislava, and Belgrade. These cities were also considered as case studies within the KULTURisk project. The structural measures are reviewed and compared to each other according to the type, duration of application, the return period of the design flood event, how the project measures are integrated into spatial planning and the problems that occur in the flood defences today. Based on this review, some suggestions are given on how to improve the flood risk management in flood-prone areas.

Prosthetic rehabilitation of oral submucous fibrosis patients: A systematic review of published case reports and case series

PubMed Central

Patil, Shankargouda; Sarode, Gargi S.; Bhandi, Shilpa; Awan, Kamran Habib; Ferrari, Marco

2017-01-01

Background Oral submucous fibrosis (OSF) is an insidious chronic condition characterized by restricted mouth opening. Prosthetic rehabilitation is challenging for OSF patients as obtaining a good impression requires adequate mouth opening. The aim of the present review is to systematically present the data from case reports published in the English-language literature. Method A comprehensive search of the literature databases (PubMed, Medline, SCOPUS, Web of Science and Google Scholar) along with the references of published articles on prosthetic rehabilitation in OSF patients published to date was conducted. Keywords included a combination of ‘Oral submucous fibrosis’, ‘prosthesis’, ‘dentures’ and/or ‘restricted mouth opening’. Citations from selected references and bibliographic linkages taken from similar cases were included in this review. The inclusion criteria selected for case reports on prosthetic rehabilitation in OSF patients, and cases of restricted mouth opening due to causes other than OSF were excluded from the study. Results A total of 21 cases were identified and analysed from 17 papers published in the English-language literature. Of these, 9 cases employed the sectional denture technique, 4 cases emphasized the need-based treatment approach in which conventional methods were modified, and 4 cases used mouth exercising devices. Finally, 1 case each involved, flexible denture, oral screen prosthesis, oral stents, surgery in conjunction with dentures. Conclusion Prosthetic rehabilitation in OSF patients is a multifaceted approach and should be patient specific, although sectional dentures have achieved the best results. PMID:28877246

Prosthetic rehabilitation of oral submucous fibrosis patients: A systematic review of published case reports and case series.

PubMed

Patil, Shankargouda; Sarode, Sachin Chakradhar; Sarode, Gargi S; Bhandi, Shilpa; Awan, Kamran Habib; Ferrari, Marco

2017-01-01

Oral submucous fibrosis (OSF) is an insidious chronic condition characterized by restricted mouth opening. Prosthetic rehabilitation is challenging for OSF patients as obtaining a good impression requires adequate mouth opening. The aim of the present review is to systematically present the data from case reports published in the English-language literature. A comprehensive search of the literature databases (PubMed, Medline, SCOPUS, Web of Science and Google Scholar) along with the references of published articles on prosthetic rehabilitation in OSF patients published to date was conducted. Keywords included a combination of 'Oral submucous fibrosis', 'prosthesis', 'dentures' and/or 'restricted mouth opening'. Citations from selected references and bibliographic linkages taken from similar cases were included in this review. The inclusion criteria selected for case reports on prosthetic rehabilitation in OSF patients, and cases of restricted mouth opening due to causes other than OSF were excluded from the study. A total of 21 cases were identified and analysed from 17 papers published in the English-language literature. Of these, 9 cases employed the sectional denture technique, 4 cases emphasized the need-based treatment approach in which conventional methods were modified, and 4 cases used mouth exercising devices. Finally, 1 case each involved, flexible denture, oral screen prosthesis, oral stents, surgery in conjunction with dentures. Prosthetic rehabilitation in OSF patients is a multifaceted approach and should be patient specific, although sectional dentures have achieved the best results.

Gliomas and exposure to wood preservatives.

PubMed Central

Cordier, S; Poisson, M; Gerin, M; Varin, J; Conso, F; Hemon, D

1988-01-01

A case-referent study was undertaken to look for occupational risk factors among patients with glioma treated in a neurological hospital in Paris between 1975 and 1984. In the study group were 125 men with gliomas (aged less than or equal to 65) and 238 patients (also less than or equal to 65) admitted for non-neoplastic, non-malformative vascular diseases in the same department during the same period constituting the reference group. All diagnoses were confirmed by tomodensitometry. Information on occupational history was obtained from a postal questionnaire and from medical records. Comparison of cases and referents showed a significant excess risk among teachers (OR = 4.1) and a raised risk among wood workers (OR = 1.6). Four of nine cases of glioma who had been employed as wood workers reported that a colleague had suffered from glioma (those reports were confirmed by hospital records). None were reported among 11 referent wood workers. Using a complementary questionnaire on wood work, exposure assessment to wood preservatives and solvents showed that frequent exposure to organochlorine wood preservatives and to organic solvents occurred more often among cases than referent wood workers (p less than 0.10). PMID:3196664

Text of the U.S. Court of Appeals Opinion in the Spirt Equal-Pension Case.

ERIC Educational Resources Information Center

Newman, Jon O.; And Others

1984-01-01

The opinion of a three-judge panel in a court case involving the validity of gender-based mortality tables and the right of women to receive equal pensions from the Teachers Insurance Annuities Association and the College Retirement Equities Fund is presented, including references to the earlier, related Norris case. (MSE)

International energy outlook 1996

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1996-05-01

This International Energy Outlook presents historical data from 1970 to 1993 and EIA`s projections of energy consumption and carbon emissions through 2015 for 6 country groups. Prospects for individual fuels are discussed. Summary tables of the IEO96 world energy consumption, oil production, and carbon emissions projections are provided in Appendix A. The reference case projections of total foreign energy consumption and of natural gas, coal, and renewable energy were prepared using EIA`s World Energy Projection System (WEPS) model. Reference case projections of foreign oil production and consumption were prepared using the International Energy Module of the National Energy Modeling Systemmore » (NEMS). Nuclear consumption projections were derived from the International Nuclear Model, PC Version (PC-INM). Alternatively, nuclear capacity projections were developed using two methods: the lower reference case projections were based on analysts` knowledge of the nuclear programs in different countries; the upper reference case was generated by the World Integrated Nuclear Evaluation System (WINES)--a demand-driven model. In addition, the NEMS Coal Export Submodule (CES) was used to derive flows in international coal trade. As noted above, foreign projections of electricity demand are now projected as part of the WEPS. 64 figs., 62 tabs.« less

Two year experience with Web connectivity to PACS at a community-based hospital

NASA Astrophysics Data System (ADS)

Wadley, Brian D.; Hayward, Ulrike; Trambert, Michael; Kywi, Alberto; Hartzman, Steven

2002-05-01

Referring physician web based access to a PACS is evaluated at a community-based hospital. Survey results show 100% perceived improvement in referring physician productivity, and 97% perceived improvement in patient care. Overall satisfaction and perception of ease of use is greater than 90%.Web connectivity to PACS is perceived by 97% to result in decreased visits and calls to the radiology department due to the availability of virtual results, with high value placed on the voice clip summary results by 94% of respondents (the voice clip is a recording made by the radiologist at the time of reading the exam, which summarizes the results of the study).The availability of exams and virtual results via web-based connectivity is perceived to result in increase referrals by 58% of respondents. Web log audit trails are analyzed to evaluate the use of the system by referring physicians. The gross number of cases retrieved over the web for a two-week period is assessed. The number of times a voice clip was played is also evaluated. The results overall show a very positive experience with web connectivity to PACS.

Frequency and Content of Chat Questions by Time of Semester at the University of Central Florida: Implications for Training, Staffing and Marketing

ERIC Educational Resources Information Center

Goda, Donna; Bishop, Corinne

2008-01-01

The more than 4,000 "chats" received by the University of Central Florida's (UCF) Ask-A-Librarian digital reference service are the subject of this practitioner-based, descriptive case study. Question content from chats received during four semesters between January 2005 and May 2006 are categorized and plotted, by semester, to show the…

Innovations in Community-Based and Interdisciplinary Research: A Network Perspective on Innovation in Social Work Science

ERIC Educational Resources Information Center

Rice, Eric; Petering, Robin; Stringfellow, Erin; Craddock, Jaih B.

2017-01-01

We present a preliminary theory of innovation in social work science. The focus of the piece is two case studies from our work that illustrate the social nature of innovations in the science of social work. This inductive theory focuses on a concept we refer to as transformative innovation, wherein two sets of individuals who possess different…

On Being Echolalic: An Analysis of the Interactional and Phonetic Aspects of an Autistic's Language.

ERIC Educational Resources Information Center

Local, John; Wootton, Tony

1996-01-01

A case study analyzed the echolalia behavior of an autistic 11-year-old boy, based on recordings made in his home and school. Focus was on the subset of immediate echolalia referred to as pure echoing. Using an approach informed by conversation analysis and descriptive phonetics, distinctions are drawn between different forms of pure echo. It is…

More than Just Language Advising: Rapport in University English Writing Consultations and Implications for Tutor Training

ERIC Educational Resources Information Center

Lee, Cynthia

2015-01-01

Adopting a case study approach with multiple data sources, this paper explores the ways in which rapport is built, and its impact on the learning process based on five successive writing support consultations between a native English-speaking (NES) tutor and her second language (L2) tutee in a Hong Kong university. With reference to the prepared…

Systems Engineering Case Studies, Synopsis of the Learning Principles

DTIC Science & Technology

2009-08-24

TBMCS refers to the Theater Battle Management Core System Systems Engineering Case Study Peacekeeper refers to the Peacekeeper Intercontinental...primary mirror defect going to orbit undetected in spite of substantial evidence that could have been used to prevent this occurrence. TBMCS /1...The requirements baseline was volatile up to system acceptance, which took place after TBMCS passed operational test and evaluation. Approved for

[Genetic characterization analysis on the first imported measles virus of genotype D8 in Chinese mainland].

PubMed

Sun, Xiao-Dong; Li, Chong-Shan; Tang, Xian; Li, Zhi; Zhang, Yan; Tang, Wei; Wang, Jing; Wang, Hui-Ling; Yang, Yan-Ji; Li, Jia; Yuan, Zheng-An; Xu, Wen-Bo

2013-11-01

This study analyzed the genetic characterization on first imported measles virus of genotype D8 in Chinese mainland. Serums were collected from the suspicious MV patients to detect IgM antibody in ELISA. Throat swabs were cultured in Vero/SLAM cell line to get measles virus isolates. Part of the nucleotide sequence of the 3' terminus of nucleoprotein (N) gene of these isolates were amplified by RT-PCR, and the amplicons were directly sequenced. The phylogenetic analysis was based on the nucleotide sequence about 456 base pairs of the 3' terminus of nucleoprotein (N) gene. Results showed that it reported 1 105 suspicious measles cases in shanghai, 2012, including 590 confirmed cases and 2 clinical case. The reported morbidity was 2.52 per one hundred thousand. 247 measles viruses were isolated from 984 throat swabs specimen. Most of them belonged to sub-genotype H1a except Shanghai12-239 was genotype D8. The homology of nucleotide and amino acid sequences were 97.8% and 98.6% respectively between Shanghai12-239 and WHO reference strain (Manchester. UNK30.94(D8)AF280803). Those were 89.6%-94.5% and 88.7%-95.3% between Shanghai12-239 and WHO reference strains of other genotypes.

Prevalence of Candida bracarensis and Candida nivariensis in a Spanish collection of yeasts: comparison of results from a reference centre and from a population-based surveillance study of candidemia.

PubMed

Cuenca-Estrella, M; Gomez-Lopez, A; Isla, G; Rodriguez, D; Almirante, B; Pahissa, A; Rodriguez-Tudela, J L

2011-07-01

Two new species related to Candida glabrata, i.e., Candida nivariensis and Candida bracarensis, have been proposed. The occurrence of these species among isolates collected in a Spanish mycology reference laboratory in 2008-2009 was reviewed. In addition, strains recovered as part of an active population-based surveillance of candidemia conducted in Barcelona between 2002 and 2003 were also analyzed. Among 143 clinical isolates received in 2008-2009, three (2%) were identified as C. bracarensis and none as C. nivariensis through sequencing of their ribosomal DNA. Of the 31 strains initially identified as C. glabrata in the 2002-2003 population-based study (0.38 cases/100,000 population), none were found to belong to these related new species. Results from in vitro susceptibility studies of C. bracarensis isolates were comparable to those found with C. glabrata. Since new and cryptic species have been described, periodic surveillance including the use of molecular identification methods seems to be necessary in order to determine their frequency, geographical distribution and susceptibility profile.

Computerized method for detection of vertebral fractures on lateral chest radiographs based on morphometric data

NASA Astrophysics Data System (ADS)

Kasai, Satoshi; Li, Feng; Shiraishi, Junji; Li, Qiang; Straus, Christopher; Vokes, Tamara; MacMahon, Heber; Doi, Kunio

2007-03-01

Vertebral fractures are the most common osteoporosis-related fractures. It is important to detect vertebral fractures, because they are associated with increased risk of subsequent fractures, and because pharmacologic therapy can reduce the risk of subsequent fractures. Although vertebral fractures are often not clinically recognized, they can be visualized on lateral chest radiographs taken for other purposes. However, only 15-60% of vertebral fractures found on lateral chest radiographs are mentioned in radiology reports. The purpose of this study was to develop a computerized method for detection of vertebral fractures on lateral chest radiographs in order to assist radiologists' image interpretation. Our computerized method is based on the automated identification of upper and lower vertebral edges. In order to develop the scheme, radiologists provided morphometric data for each identifiable vertebra, which consisted of six points for each vertebra, for 25 normals and 20 cases with severe fractures. Anatomical information was obtained from morphometric data of normal cases in terms of vertebral heights, heights of vertebral disk spaces, and vertebral centerline. Computerized detection of vertebral fractures was based on the reduction in the heights of fractured vertebrae compared to adjacent vertebrae and normal reference data. Vertebral heights from morphometric data on normal cases were used as reference. On 138 chest radiographs (20 with fractures) the sensitivity of our method for detection of fracture cases was 95% (19/20) with 0.93 (110/118) false-positives per image. In conclusion, the computerized method would be useful for detection of potentially overlooked vertebral fractures on lateral chest radiographs.

Assessment of the French National Health Insurance Information System as a tool for epidemiological surveillance of malaria.

PubMed

Delon, François; Mayet, Aurélie; Thellier, Marc; Kendjo, Eric; Michel, Rémy; Ollivier, Lénaïck; Chatellier, Gilles; Desjeux, Guillaume

2017-05-01

Epidemiological surveillance of malaria in France is based on a hospital laboratory sentinel surveillance network. There is no comprehensive population surveillance. The objective of this study was to assess the ability of the French National Health Insurance Information System to support nationwide malaria surveillance in continental France. A case identification algorithm was built in a 2-step process. First, inclusion rules giving priority to sensitivity were defined. Then, based on data description, exclusion rules to increase specificity were applied. To validate our results, we compared them to data from the French National Reference Center for Malaria on case counts, distribution within subgroups, and disease onset date trends. We built a reusable automatized tool. From July 1, 2013, to June 30, 2014, we identified 4077 incident malaria cases that occurred in continental France. Our algorithm provided data for hospitalized patients, patients treated by private physicians, and outpatients for the entire population. Our results were similar to those of the National Reference Center for Malaria for each of the outcome criteria. We provided a reliable algorithm for implementing epidemiological surveillance of malaria based on the French National Health Insurance Information System. Our method allowed us to work on the entire population living in continental France, including subpopulations poorly covered by existing surveillance methods. Traditional epidemiological surveillance and the approach presented in this paper are complementary, but a formal validation framework for case identification algorithms is necessary. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

[Application of ARIMA model to predict number of malaria cases in China].

PubMed

Hui-Yu, H; Hua-Qin, S; Shun-Xian, Z; Lin, A I; Yan, L U; Yu-Chun, C; Shi-Zhu, L I; Xue-Jiao, T; Chun-Li, Y; Wei, H U; Jia-Xu, C

2017-08-15

Objective To study the application of autoregressive integrated moving average (ARIMA) model to predict the monthly reported malaria cases in China, so as to provide a reference for prevention and control of malaria. Methods SPSS 24.0 software was used to construct the ARIMA models based on the monthly reported malaria cases of the time series of 20062015 and 2011-2015, respectively. The data of malaria cases from January to December, 2016 were used as validation data to compare the accuracy of the two ARIMA models. Results The models of the monthly reported cases of malaria in China were ARIMA (2, 1, 1) (1, 1, 0) 12 and ARIMA (1, 0, 0) (1, 1, 0) 12 respectively. The comparison between the predictions of the two models and actual situation of malaria cases showed that the ARIMA model based on the data of 2011-2015 had a higher accuracy of forecasting than the model based on the data of 2006-2015 had. Conclusion The establishment and prediction of ARIMA model is a dynamic process, which needs to be adjusted unceasingly according to the accumulated data, and in addition, the major changes of epidemic characteristics of infectious diseases must be considered.

Optical character recognition based on nonredundant correlation measurements.

PubMed

Braunecker, B; Hauck, R; Lohmann, A W

1979-08-15

The essence of character recognition is a comparison between the unknown character and a set of reference patterns. Usually, these reference patterns are all possible characters themselves, the whole alphabet in the case of letter characters. Obviously, N analog measurements are highly redundant, since only K = log(2)N binary decisions are enough to identify one out of N characters. Therefore, we devised K reference patterns accordingly. These patterns, called principal components, are found by digital image processing, but used in an optical analog computer. We will explain the concept of principal components, and we will describe experiments with several optical character recognition systems, based on this concept.

Combining near- and far-field exposure for an organ-specific and whole-body RF-EMF proxy for epidemiological research: a reference case.

PubMed

Lauer, Oliver; Frei, Patrizia; Gosselin, Marie-Christine; Joseph, Wout; Röösli, Martin; Fröhlich, Jürg

2013-07-01

A framework for the combination of near-field (NF) and far-field (FF) radio frequency electromagnetic exposure sources to the average organ and whole-body specific absorption rates (SARs) is presented. As a reference case, values based on numerically derived SARs for whole-body and individual organs and tissues are combined with realistic exposure data, which have been collected using personal exposure meters during the Swiss Qualifex study. The framework presented can be applied to any study region where exposure data is collected by appropriate measurement equipment. Based on results derived from the data for the region of Basel, Switzerland, the relative importance of NF and FF sources to the personal exposure is examined for three different study groups. The results show that a 24-h whole-body averaged exposure of a typical mobile phone user is dominated by the use of his or her own mobile phone when a Global System for Mobile Communications (GSM) 900 or GSM 1800 phone is used. If only Universal Mobile Telecommunications System (UMTS) phones are used, the user would experience a lower exposure level on average caused by the lower average output power of UMTS phones. Data presented clearly indicate the necessity of collecting band-selective exposure data in epidemiological studies related to electromagnetic fields. Copyright © 2013 Wiley Periodicals, Inc.

Laboratory study of sonic booms and their scaling laws. [ballistic range simulation

NASA Technical Reports Server (NTRS)

Toong, T. Y.

1974-01-01

This program undertook to seek a basic understanding of non-linear effects associated with caustics, through laboratory simulation experiments of sonic booms in a ballistic range and a coordinated theoretical study of scaling laws. Two cases of superbooms or enhanced sonic booms at caustics have been studied. The first case, referred to as acceleration superbooms, is related to the enhanced sonic booms generated during the acceleration maneuvers of supersonic aircrafts. The second case, referred to as refraction superbooms, involves the superbooms that are generated as a result of atmospheric refraction. Important theoretical and experimental results are briefly reported.

No Evidence for Disease History as a Risk Factor for Narcolepsy after A(H1N1)pdm09 Vaccination.

PubMed

Lamb, Favelle; Ploner, Alexander; Fink, Katharina; Maeurer, Markus; Bergman, Peter; Piehl, Fredrik; Weibel, Daniel; Sparén, Pär; Dahlström, Lisen Arnheim

2016-01-01

To investigate disease history before A(H1N1)pdm09 vaccination as a risk factor for narcolepsy. Case-control study in Sweden. Cases included persons referred for a Multiple Sleep Latency Test between 2009 and 2010, identified through diagnostic sleep centres and confirmed through independent review of medical charts. Controls, selected from the total population register, were matched to cases on age, gender, MSLT-referral date and county of residence. Disease history (prescriptions and diagnoses) and vaccination history was collected through telephone interviews and population-based healthcare registers. Conditional logistic regression was used to investigate disease history before A(H1N1)pdm09 vaccination as a risk-factor for narcolepsy. In total, 72 narcolepsy cases and 251 controls were included (range 3-69 years mean19-years). Risk of narcolepsy was increased in individuals with a disease history of nervous system disorders (OR range = 3.6-8.8) and mental and behavioural disorders (OR = 3.8, 95% CI 1.6-8.8) before referral. In a second analysis of vaccinated individuals only, nearly all initial associations were no longer statistically significant and effect sizes were smaller (OR range = 1.3-2.6). A significant effect for antibiotics (OR = 0.4, 95% CI 0.2-0.8) and a marginally significant effect for nervous system disorders was observed. In a third case-only analysis, comparing cases referred before vaccination to those referred after; prescriptions for nervous system disorders (OR = 26.0 95% CI 4.0-170.2) and ADHD (OR = 35.3 95% CI 3.4-369.9) were statistically significant during the vaccination period, suggesting initial associations were due to confounding by indication. The findings of this study do not support disease history before A(H1N1)pdm09 vaccination as a risk factor for narcolepsy.

Using vignettes to assess contributions to the work of addressing child mental health problems in primary care.

PubMed

Wissow, Lawrence S; Zafar, Waleed; Fothergill, Kate; Ruble, Anne; Slade, Eric

2016-01-22

To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77% female, 58% at their site 10 or more years; 44% in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50%) increase in work (95% CL .94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P < .001) while medical co-morbidity increased it the least (.44 units, p < .001). Factors most strongly associated with increased overall work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work ratings than did those without co-located staff. Both diagnosis and cross-diagnosis complicating factors contribute to the work involved in providing mental health services in primary care. Vignette studies may facilitate understanding which mental health services can be most readily incorporated into primary care as it is presently structured and help guide the design of training programs and other implementation strategies.

Costs and consequences of automated algorithms versus manual grading for the detection of referable diabetic retinopathy.

PubMed

Scotland, G S; McNamee, P; Fleming, A D; Goatman, K A; Philip, S; Prescott, G J; Sharp, P F; Williams, G J; Wykes, W; Leese, G P; Olson, J A

2010-06-01

To assess the cost-effectiveness of an improved automated grading algorithm for diabetic retinopathy against a previously described algorithm, and in comparison with manual grading. Efficacy of the alternative algorithms was assessed using a reference graded set of images from three screening centres in Scotland (1253 cases with observable/referable retinopathy and 6333 individuals with mild or no retinopathy). Screening outcomes and grading and diagnosis costs were modelled for a cohort of 180 000 people, with prevalence of referable retinopathy at 4%. Algorithm (b), which combines image quality assessment with detection algorithms for microaneurysms (MA), blot haemorrhages and exudates, was compared with a simpler algorithm (a) (using image quality assessment and MA/dot haemorrhage (DH) detection), and the current practice of manual grading. Compared with algorithm (a), algorithm (b) would identify an additional 113 cases of referable retinopathy for an incremental cost of pound 68 per additional case. Compared with manual grading, automated grading would be expected to identify between 54 and 123 fewer referable cases, for a grading cost saving between pound 3834 and pound 1727 per case missed. Extrapolation modelling over a 20-year time horizon suggests manual grading would cost between pound 25,676 and pound 267,115 per additional quality adjusted life year gained. Algorithm (b) is more cost-effective than the algorithm based on quality assessment and MA/DH detection. With respect to the value of introducing automated detection systems into screening programmes, automated grading operates within the recommended national standards in Scotland and is likely to be considered a cost-effective alternative to manual disease/no disease grading.

Severe versus Moderate Criteria for the New Pediatric Case Definition for ME/CFS

ERIC Educational Resources Information Center

Jason, Leonard; Porter, Nicole; Shelleby, Elizabeth; Till, Lindsay; Bell, David S.; Lapp, Charles W.; Rowe, Kathy; De Meirleir, Kenny

2009-01-01

The new diagnostic criteria for pediatric ME/CFS are structurally based on the Canadian Clinical Adult case definition, and have more required specific symptoms than the (Fukuda et al. Ann Intern Med 121:953-959, 1994) adult case definition. Physicians specializing in pediatric ME/CFS referred thirty-three pediatric patients with ME/CFS and 21…

Health-Care Referrals from Direct-to-Consumer Genetic Testing

PubMed Central

Giovanni, Monica A.; Fickie, Matthew R.; Lehmann, Lisa S.; Green, Robert C.; Meckley, Lisa M.; Veenstra, David

2010-01-01

Background: Direct-to-consumer genetic testing (DTC-GT) provides personalized genetic risk information directly to consumers. Little is known about how and why consumers then communicate the results of this testing to health-care professionals. Aim: To query specialists in clinical genetics about their experience with individuals who consulted them after DTC-GT. Methods: Invitations to participate in a questionnaire were sent to three different groups of genetic professionals, totaling 4047 invitations, asking questions about individuals who consulted them after DTC-GT. For each case reported, respondents were asked to describe how the case was referred to them, the patient's rationale for DTC-GT, and the type of DTC-GT performed. Respondents were also queried about the consequences of the consultations in terms of additional testing ordered. The costs associated with each consultation were estimated. A clinical case series was compiled based upon clinician responses. Results: The invitation resulted in 133 responses describing 22 cases of clinical interactions following DTC-GT. Most consultations (59.1%) were self-referred to genetics professionals, but 31.8% were physician referred. Among respondents, 52.3% deemed the DTC-GT to be “clinically useful.” BRCA1/2 testing was considered clinically useful in 85.7% of cases; 35.7% of other tests were considered clinically useful. Subsequent referrals from genetics professionals to specialists and/or additional diagnostic testing were common, generating individual downstream costs estimated to range from $40 to $20,600. Conclusions: This clinical case series suggests that approximately half of clinical geneticists who saw patients after DTC-GT judged that testing was clinically useful, especially the BRCA1/2 testing. Further studies are needed in larger and more diverse populations to better understand the interactions between DTC-GT and the health-care system. PMID:20979566

Health-care referrals from direct-to-consumer genetic testing.

PubMed

Giovanni, Monica A; Fickie, Matthew R; Lehmann, Lisa S; Green, Robert C; Meckley, Lisa M; Veenstra, David; Murray, Michael F

2010-12-01

direct-to-consumer genetic testing (DTC-GT) provides personalized genetic risk information directly to consumers. Little is known about how and why consumers then communicate the results of this testing to health-care professionals. to query specialists in clinical genetics about their experience with individuals who consulted them after DTC-GT. invitations to participate in a questionnaire were sent to three different groups of genetic professionals, totaling 4047 invitations, asking questions about individuals who consulted them after DTC-GT. For each case reported, respondents were asked to describe how the case was referred to them, the patient's rationale for DTC-GT, and the type of DTC-GT performed. Respondents were also queried about the consequences of the consultations in terms of additional testing ordered. The costs associated with each consultation were estimated. A clinical case series was compiled based upon clinician responses. the invitation resulted in 133 responses describing 22 cases of clinical interactions following DTC-GT. Most consultations (59.1%) were self-referred to genetics professionals, but 31.8% were physician referred. Among respondents, 52.3% deemed the DTC-GT to be "clinically useful." BRCA1/2 testing was considered clinically useful in 85.7% of cases; 35.7% of other tests were considered clinically useful. Subsequent referrals from genetics professionals to specialists and/or additional diagnostic testing were common, generating individual downstream costs estimated to range from $40 to $20,600. this clinical case series suggests that approximately half of clinical geneticists who saw patients after DTC-GT judged that testing was clinically useful, especially the BRCA1/2 testing. Further studies are needed in larger and more diverse populations to better understand the interactions between DTC-GT and the health-care system.

Validation of a case definition for leptospirosis diagnosis in patients with acute severe febrile disease admitted in reference hospitals at the State of Pernambuco, Brazil.

PubMed

Albuquerque Filho, Alfredo Pereira Leite de; Araújo, Jéssica Guido de; Souza, Inacelli Queiroz de; Martins, Luciana Cardoso; Oliveira, Marta Iglis de; Silva, Maria Jesuíta Bezerra da; Montarroyos, Ulisses Ramos; Miranda Filho, Demócrito de Barros

2011-01-01

Leptospirosis is often mistaken for other acute febrile illnesses because of its nonspecific presentation. Bacteriologic, serologic, and molecular methods have several limitations for early diagnosis: technical complexity, low availability, low sensitivity in early disease, or high cost. This study aimed to validate a case definition, based on simple clinical and laboratory tests, that is intended for bedside diagnosis of leptospirosis among hospitalized patients. Adult patients, admitted to two reference hospitals in Recife, Brazil, with a febrile illness of less than 21 days and with a clinical suspicion of leptospirosis, were included to test a case definition comprising ten clinical and laboratory criteria. Leptospirosis was confirmed or excluded by a composite reference standard (microscopic agglutination test, ELISA, and blood culture). Test properties were determined for each cutoff number of the criteria from the case definition. Ninety seven patients were included; 75 had confirmed leptospirosis and 22 did not. Mean number of criteria from the case definition that were fulfilled was 7.8±1.2 for confirmed leptospirosis and 5.9±1.5 for non-leptospirosis patients (p<0.0001). Best sensitivity (85.3%) and specificity (68.2%) combination was found with a cutoff of 7 or more criteria, reaching positive and negative predictive values of 90.1% and 57.7%, respectively; accuracy was 81.4%. The case definition, for a cutoff of at least 7 criteria, reached average sensitivity and specificity, but with a high positive predictive value. Its simplicity and low cost make it useful for rapid bedside leptospirosis diagnosis in Brazilian hospitalized patients with acute severe febrile disease.

Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies

PubMed Central

2010-01-01

Background Vitamin D supplementation for fracture prevention is widespread despite conflicting interpretation of relevant randomised controlled trial (RCT) evidence. This study summarises quantitatively the current evidence from RCTs and observational studies regarding vitamin D, parathyroid hormone (PTH) and hip fracture risk. Methods We undertook separate meta-analyses of RCTs examining vitamin D supplementation and hip fracture, and observational studies of serum vitamin D status (25-hydroxyvitamin D (25(OH)D) level), PTH and hip fracture. Results from RCTs were combined using the reported hazard ratios/relative risks (RR). Results from case-control studies were combined using the ratio of 25(OH)D and PTH measurements of hip fracture cases compared with controls. Original published studies of vitamin D, PTH and hip fracture were identified through PubMed and Web of Science databases, searches of reference lists and forward citations of key papers. Results The seven eligible RCTs identified showed no significant difference in hip fracture risk in those randomised to cholecalciferol or ergocalciferol supplementation versus placebo/control (RR = 1.13[95%CI 0.98-1.29]; 801 cases), with no significant difference between trials of <800 IU/day and ≥800 IU/day. The 17 identified case-control studies found 33% lower serum 25(OH)D levels in cases compared to controls, based on 1903 cases. This difference was significantly greater in studies with population-based compared to hospital-based controls (χ21 (heterogeneity) = 51.02, p < 0.001) and significant heterogeneity was present overall (χ216 (heterogeneity) = 137.9, p < 0.001). Serum PTH levels in hip fracture cases did not differ significantly from controls, based on ten case-control studies with 905 cases (χ29 (heterogeneity) = 149.68, p < 0.001). Conclusions Neither higher nor lower dose vitamin D supplementation prevented hip fracture. Randomised and observational data on vitamin D and hip fracture appear to differ. The reason for this is unclear; one possible explanation is uncontrolled confounding in observational studies. Post-fracture PTH levels are unrelated to hip fracture risk. PMID:20540727

Process-based reference conditions: An alternative approach for managed river systems

NASA Astrophysics Data System (ADS)

Grams, P.; Melis, T.; Wright, S.; Schmidt, J.; Topping, D.

2008-12-01

Physical reference conditions, whether based on historic information or the condition of nearby less impaired systems, provide necessary information that contributes to an assessment of stream condition and the nature of channel transformation. In many cases, however, the utility of this traditional 'reference' approach may end at the assessment stage and not be applicable to establishing and implementing restoration goals. Ongoing impacts such as continued existence of an upstream dam or the persistence of invasive vegetation may render restoration based on a physical reference infeasible. In these circumstances, an alternative approach is to identify and describe reference processes in place of physical reference conditions. This is the case for the Colorado River where large dams, a commitment to hydropower production, and legal mandates for regional distribution and off- channel consumption of water greatly reduce the relevance of historical conditions in setting goals for rehabilitation. In this setting, two strategies are available for setting reference conditions. One is maintenance of post-dam sediment mass balance, which attempts to ensure that the channel does not continue to degrade or aggrade and that riverine habitats do not continue to diverge from their historical condition. Post- dam sediment mass balance can be quantified at a reconnaissance or project scale. The second strategy is to define key processes that maintain the native ecosystem. These processes may, or may not, be consistent with maintenance of sediment mass balance, but they may be key to rejuvenation of spawning and rearing habitats, maintenance of historical ranges of temperature and turbidity, maintenance of a sustainable food base for the native aquatic community, or maintaining other riverine resources. Both strategies require careful monitoring of processes (e.g. sediment flux), which may add considerably to the cost and complexity of a monitoring program. An additional challenge in adopting the second strategy is that it is difficult to define when a process is adequately restored, since many ecosystem processes collectively limit recovery of populations of native communities.

Relevance of workplace social mixing during influenza pandemics: an experimental modelling study of workplace cultures.

PubMed

Timpka, T; Eriksson, H; Holm, E; Strömgren, M; Ekberg, J; Spreco, A; Dahlström, Ö

2016-07-01

Workplaces are one of the most important regular meeting places in society. The aim of this study was to use simulation experiments to examine the impact of different workplace cultures on influenza dissemination during pandemics. The impact is investigated by experiments with defined social-mixing patterns at workplaces using semi-virtual models based on authentic sociodemographic and geographical data from a North European community (population 136 000). A simulated pandemic outbreak was found to affect 33% of the total population in the community with the reference academic-creative workplace culture; virus transmission at the workplace accounted for 10·6% of the cases. A model with a prevailing industrial-administrative workplace culture generated 11% lower incidence than the reference model, while the model with a self-employed workplace culture (also corresponding to a hypothetical scenario with all workplaces closed) produced 20% fewer cases. The model representing an academic-creative workplace culture with restricted workplace interaction generated 12% lower cumulative incidence compared to the reference model. The results display important theoretical associations between workplace social-mixing cultures and community-level incidence rates during influenza pandemics. Social interaction patterns at workplaces should be taken into consideration when analysing virus transmission patterns during influenza pandemics.

A pilot prospective feasibility study of organ-at-risk definition using Target Contour Testing/Instructional Computer Software (TaCTICS), a training and evaluation platform for radiotherapy target delineation.

PubMed

Kalpathy-Cramer, Jayashree; Bedrick, Steven D; Boccia, Kelly; Fuller, Clifton D

2011-01-01

Target volume delineation is a critical, but time-consuming step in the creation of radiation therapy plans used in the treatment of many types of cancer. However, variability in target volume definitions can introduce substantial differences in resulting doses to tumors and critical structures. We developed TaCTICS, a web-based educational training software application targeted towards non-expert users. We report on a small, prospective study to evaluate the utility of this online tool in improving conformance of regions-of-interest (ROIs) with a reference set. Eight residents contoured a set of structures for a head-and-neck cancer case. Subsequently, they were provided access to TaCTICS as well as contouring atlases to allow evaluation of their contours in reference to other users as well as reference ROIs. The residents then contoured a second case using these resources. Volume overlap metrics between the users showed a substantial improvement following the intervention. Additionally, 66% of users reported that they found TaCTICS to be a useful educational tool and all participants reported they would like to use TaCTICS to track their contouring skills over the course of their residency.

RANS Simulation (Rotating Reference Frame Model [RRF]) of Single Lab-Scaled DOE RM1 MHK Turbine

DOE Data Explorer

Javaherchi, Teymour; Stelzenmuller, Nick; Aliseda, Alberto; Seydel, Joseph

2014-04-15

Attached are the .cas and .dat files for the Reynolds Averaged Navier-Stokes (RANS) simulation of a single lab-scaled DOE RM1 turbine implemented in ANSYS FLUENT CFD-package. The lab-scaled DOE RM1 is a re-design geometry, based of the full scale DOE RM1 design, producing same power output as the full scale model, while operating at matched Tip Speed Ratio values at reachable laboratory Reynolds number (see attached paper). In this case study taking advantage of the symmetry of lab-scaled DOE RM1 geometry, only half of the geometry is models using (Single) Rotating Reference Frame model [RRF]. In this model RANS equations, coupled with k-\\omega turbulence closure model, are solved in the rotating reference frame. The actual geometry of the turbine blade is included and the turbulent boundary layer along the blade span is simulated using wall-function approach. The rotation of the blade is modeled by applying periodic boundary condition to sets of plane of symmetry. This case study simulates the performance and flow field in the near and far wake of the device at the desired operating conditions. The results of these simulations were validated against in-house experimental data. Please see the attached paper.

Linear time-dependent reference intervals where there is measurement error in the time variable-a parametric approach.

PubMed

Gillard, Jonathan

2015-12-01

This article re-examines parametric methods for the calculation of time specific reference intervals where there is measurement error present in the time covariate. Previous published work has commonly been based on the standard ordinary least squares approach, weighted where appropriate. In fact, this is an incorrect method when there are measurement errors present, and in this article, we show that the use of this approach may, in certain cases, lead to referral patterns that may vary with different values of the covariate. Thus, it would not be the case that all patients are treated equally; some subjects would be more likely to be referred than others, hence violating the principle of equal treatment required by the International Federation for Clinical Chemistry. We show, by using measurement error models, that reference intervals are produced that satisfy the requirement for equal treatment for all subjects. © The Author(s) 2011.

Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain

PubMed Central

Laslett, Mark; McDonald, Barry; Tropp, Hans; Aprill, Charles N; Öberg, Birgitta

2005-01-01

Background The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. Methods We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC) statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses. Results In a sample of chronic LBP patients (n = 216) with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement (PCC) was estimated at 13%. "Exact" agreement between clinical and reference standard diagnoses was 32% and "clinical agreement" 51%. For six pathoanatomic categories (disc, facet joint, sacroiliac joint, hip joint, nerve root and spinal stenosis), PCC was 33% with actual agreement 56%. There was no overlap of 95% confidence intervals on any comparison. Diagnostic agreement on the six most common patho-anatomic categories produced a kappa of 0.31. Conclusion Clinical diagnoses agree with reference standards diagnoses more often than chance. Using available reference standards, most patients can have a tissue source of pain identified. PMID:15943873

Treating disorganized attachment in the Group Attachment-Based Intervention (GABI©): A case study.

PubMed

Knafo, Hannah; Murphy, Anne; Steele, Howard; Steele, Miriam

2018-05-24

This paper describes the treatment of a mother and child who demonstrated disorganized attachment behaviors in their interactions with one another. The mother, who was diagnosed with Borderline Personality Disorder, felt incapable of managing her aggressive toddler and his emotional needs. The dyad was referred for therapy due to concerns about his developmental progress, evident delays having been mainly attributed to the problems observed within the parent-child relationship. The primary intervention applied to working with the dyad was the Group Attachment-Based Intervention (GABI©), developed by Anne Murphy in collaboration with Miriam Steele and Howard Steele. The mother also received individual psychotherapy as a supplement to the dyadic and group work of GABI©. The process and outcome of this comprehensive approach to treating a vulnerable dyad is explored in this case study. © 2018 Wiley Periodicals, Inc.

Evaluation of a case-based urology learning program.

PubMed

Mishra, Kirtishri; Snow-Lisy, Devon C; Ross, Jonathan; Goldfarb, David A; Goldman, Howard; Campbell, Steven C

2013-12-01

To address the challenges that today's trainees encounter, such as information overload and reduced immersion in the field, and recognizing their preference for novel educational resources, an electronic case-based urology learning program was developed. Each case was designed to illustrate the basic principles of the disease process and the fundamentals of evaluation and management using the Socratic method, recapitulating a prototypical patient encounter. A 21-question survey was developed after review of published reports of classroom and clinical learning environment surveys. The target group was 2 pilot urology training programs (the Cleveland Clinic and University Hospitals-Case Medical Center). The responses were entirely anonymous. A total of 32 trainees participated (8 fellows and 24 residents), representing a 53% response rate. Most trainees (79%) were able to process cases within an average of ≤ 10 minutes. Of the trainees, 91% reported referring back to particular cases for patient care, to review for examinations, or for studying. Most trainees believed a case-based urology learning program would be a potentially important resource for clinical practice (69%) and for preparing for the in-service (63%) or board (69%) examinations. Most trainees believed the program met its goals of illustrating the basics principles of the disease process (88%), outlining the fundamentals of evaluation and management (94%), and improving the trainees' knowledge base (91%). An electronic case-based urology learning program is feasible and useful and stimulates learning at all trainee levels. Copyright © 2013 Elsevier Inc. All rights reserved.

An assessment of the inter-rater reliability of the ASA physical status score in the orthopaedic trauma population.

PubMed

Ihejirika, Rivka C; Thakore, Rachel V; Sathiyakumar, Vasanth; Ehrenfeld, Jesse M; Obremskey, William T; Sethi, Manish K

2015-04-01

Although recent literature has demonstrated the utility of the ASA score in predicting postoperative length of stay, complication risk and potential utilization of other hospital resources, the ASA score has been inconsistently assigned by anaesthesia providers. This study tested the reliability of assignment of the ASA score classification by both attending anaesthesiologists and anaesthesia residents specifically among the orthopaedic trauma patient population. Nine case-based scenarios were created involving preoperative patients with isolated operative orthopaedic trauma injuries. The cases were created and assigned a reference score by both an attending anaesthesiologist and orthopaedic trauma surgeon. Attending and resident anaesthesiologists were asked to assign an ASA score for each case. Rater versus reference and inter-rater agreement amongst respondents was then analyzed utilizing Fleiss's Kappa and weighted and unweighted Cohen's Kappa. Thirty three individuals provided ASA scores for each of the scenarios. The average rater versus reference reliability was substantial (Kw=0.78, SD=0.131, 95% CI=0.73-0.83). The average rater versus reference Kuw was also substantial (Kuw=0.64, SD=0.21, 95% CI=0.56-0.71). The inter-rater reliability as evaluated by Fleiss's Kappa was moderate (K=0.51, p<.001). An inter-rater comparison within the group of attendings (K=0.50, p<.001) and within the group of residents were both moderate (K=0.55, p<.001). There was a significant increase in the level of inter-rater reliability from the self-reported 'very uncomfortable' participants to the 'very comfortable' participants (uncomfortable K=0.43, comfortable K=0.59, p<.001). This study shows substantial agreement strength for reliability of the ASA score among anaesthesiologists when evaluating orthopaedic trauma patients. The significant increase in inter-rater reliability based on anaesthesiologists' comfort with the ASA scoring method implies a need for further evaluation of ASA assessment training and routine use on the ground. These findings support the use of the ASA score as a statistically reliable tool in orthopaedic trauma. Copyright © 2014 Elsevier Ltd. All rights reserved.

Northern Alberta remote teleglaucoma program: clinical outcomes and patient disposition.

PubMed

Verma, Sanam; Arora, Sourabh; Kassam, Faazil; Edwards, Marianne C; Damji, Karim F

2014-04-01

To review the diagnostic outcomes and clinical referral pathways of patients assessed and managed through a collaborative care patient-centred teleglaucoma program. Retrospective cohort study. Eligible patients were those assessed by the referring optometrist or ophthalmologist to be open-angle glaucoma suspects or to have definite early open-angle glaucoma. A glaucoma specialist graded each case through virtual consultation. Clinical referral pathways were noted: in-person consultation with glaucoma specialist, repeat teleconsultation, collaborative glaucoma management with optometrist, or referral for nonglaucomatous ophthalmic pathology. A total of 247 patients were referred to the program from 2008 to 2012. Of all teleconsults, 31.1% were diagnosed with glaucoma, 42.1% were suspects, and 26.7% were unaffected. Of all patients, 27% were referred for in-person glaucoma evaluation; 69% of patients could be managed by their referring optometrist, with 48% of patients requiring repeat teleconsultation. Treatment was initiated before being seen for 87% of patients with definite glaucoma and 28% of glaucoma suspects. Of all patients seen through the remote teleglaucoma program, most did not require an in-person consultation with an ophthalmologist and could be managed through distance collaboration. For the approximately one third who were diagnosed with glaucoma based on virtual assessment, medication was started in the majority of cases and in-person consultation was arranged. Further studies to validate and consider cost-effectiveness of this system are under way. © 2013 Canadian Ophthalmological Society Published by Canadian Ophthalmological Society All rights reserved.

A Modular Approach to Model Oscillating Control Surfaces Using Navier Stokes Equations

NASA Technical Reports Server (NTRS)

Guruswamy, Guru P.; Lee, Henry

2014-01-01

The use of active controls for rotorcraft is becoming more important for modern aerospace configurations. Efforts to reduce the vibrations of helicopter blades with use of active-controls are in progress. Modeling oscillating control surfaces using the linear aerodynamics theory is well established. However, higher-fidelity methods are needed to account for nonlinear effects, such as those that occur in transonic flow. The aeroelastic responses of a wing with an oscillating control surface, computed using the transonic small perturbation (TSP) theory, have been shown to cause important transonic flow effects such as a reversal of control surface effectiveness that occurs as the shock wave crosses the hinge line. In order to account for flow complexities such as blade-vortex interactions of rotor blades higher-fidelity methods based on the Navier-Stokes equations are used. Reference 6 presents a procedure that uses the Navier-Stokes equations with moving-sheared grids and demonstrates up to 8 degrees of control-surface amplitude, using a single grid. Later, this procedure was extended to accommodate larger amplitudes, based on sliding grid zones. The sheared grid method implemented in EulerlNavier-Stokes-based aeroelastic code ENS AERO was successfully applied to active control design by industry. Recently there are several papers that present results for oscillating control surface using Reynolds Averaged Navier-Stokes (RANS) equations. References 9 and 10 report 2-D cases by filling gaps with overset grids. Reference 9 compares integrated forces with the experiment at low oscillating frequencies whereas Ref. 10 reports parametric studies but with no validation. Reference II reports results for a 3D case by modeling the gap region with a deformed grid and compares force results with the experiment only at the mid-span of flap. In Ref. II grid is deformed to match the control surface deflections at the section where the measurements are made. However, there is no indication in Ref. II that the gaps are explicitly modeled as in Ref. 6. Computations using overset grids are reported in Ref. 12 for a case by adding moving control surface to an existing blade but with no validation either with an experiment or another computation.

Important Variables When Screening for Students at Suicidal Risk: Findings from the French Cohort of the SEYLE Study.

PubMed

Kahn, Jean-Pierre; Tubiana, Alexandra; Cohen, Renaud F; Carli, Vladimir; Wasserman, Camilla; Hoven, Christina; Sarchiapone, Marco; Wasserman, Danuta

2015-09-30

Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded "Saving and Empowering Young Lives in Europe" (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE's two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician's motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and negative life events (35%) were the main reasons for referrals. Thus, not only the classical psychopathological symptoms, such as depression, anxiety, and suicidal behaviours, but also negative life events and poor social relationships (especially isolation) motivate referrals for treatment.

Important Variables When Screening for Students at Suicidal Risk: Findings from the French Cohort of the SEYLE Study

PubMed Central

Kahn, Jean-Pierre; Tubiana, Alexandra; Cohen, Renaud F.; Carli, Vladimir; Wasserman, Camilla; Hoven, Christina; Sarchiapone, Marco; Wasserman, Danuta

2015-01-01

Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE’s two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician’s motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and negative life events (35%) were the main reasons for referrals. Thus, not only the classical psychopathological symptoms, such as depression, anxiety, and suicidal behaviours, but also negative life events and poor social relationships (especially isolation) motivate referrals for treatment. PMID:26437422

Surgical implications and variability in the use of the flat epithelial atypia diagnosis on breast biopsy specimens.

PubMed

Samples, Laura S; Rendi, Mara H; Frederick, Paul D; Allison, Kimberly H; Nelson, Heidi D; Morgan, Thomas R; Weaver, Donald L; Elmore, Joann G

2017-08-01

Flat epithelial atypia (FEA) is a relatively new diagnostic term with uncertain clinical significance for surgical management. Any implied risk of invasive breast cancer associated with FEA is contingent upon diagnostic reproducibility, yet little is known regarding its use. Pathologists in the Breast Pathology Study interpreted one of four 60-case test sets, one slide per case, constructed from 240 breast biopsy specimens. An electronic data form with standardized diagnostic categories was used; participants were instructed to indicate all diagnoses present. We assessed participants' use of FEA as a diagnostic term within: 1) each test set; 2) 72 cases classified by reference as benign without FEA; and 3) six cases classified by reference as FEA. 115 pathologists participated, providing 6900 total independent assessments. Notation of FEA ranged from 0% to 35% of the cases interpreted, with most pathologists noting FEA on 4 or more test cases. At least one participant noted FEA in 34 of the 72 benign non-FEA cases. For the 6 reference FEA cases, participant agreement with the case reference FEA diagnosis ranged from 17% to 52%; diagnoses noted by participating pathologists for these FEA cases included columnar cell hyperplasia, usual ductal hyperplasia, atypical lobular hyperplasia, and atypical ductal hyperplasia. We observed wide variation in the diagnosis of FEA among U.S. pathologists. This suggests that perceptions of diagnostic criteria and any implied risk associated with FEA may also vary. Surgical excision following a core biopsy diagnosis of FEA should be reconsidered and studied further. Copyright © 2017 Elsevier Ltd. All rights reserved.

Generic Argillite/Shale Disposal Reference Case

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zheng, Liange; Colon, Carlos Jové; Bianchi, Marco

Radioactive waste disposal in a deep subsurface repository hosted in clay/shale/argillite is a subject of widespread interest given the desirable isolation properties, geochemically reduced conditions, and widespread geologic occurrence of this rock type (Hansen 2010; Bianchi et al. 2013). Bianchi et al. (2013) provides a description of diffusion in a clay-hosted repository based on single-phase flow and full saturation using parametric data from documented studies in Europe (e.g., ANDRA 2005). The predominance of diffusive transport and sorption phenomena in this clay media are key attributes to impede radionuclide mobility making clay rock formations target sites for disposal of high-level radioactivemore » waste. The reports by Hansen et al. (2010) and those from numerous studies in clay-hosted underground research laboratories (URLs) in Belgium, France and Switzerland outline the extensive scientific knowledge obtained to assess long-term clay/shale/argillite repository isolation performance of nuclear waste. In the past several years under the UFDC, various kinds of models have been developed for argillite repository to demonstrate the model capability, understand the spatial and temporal alteration of the repository, and evaluate different scenarios. These models include the coupled Thermal-Hydrological-Mechanical (THM) and Thermal-Hydrological-Mechanical-Chemical (THMC) models (e.g. Liu et al. 2013; Rutqvist et al. 2014a, Zheng et al. 2014a) that focus on THMC processes in the Engineered Barrier System (EBS) bentonite and argillite host hock, the large scale hydrogeologic model (Bianchi et al. 2014) that investigates the hydraulic connection between an emplacement drift and surrounding hydrogeological units, and Disposal Systems Evaluation Framework (DSEF) models (Greenberg et al. 2013) that evaluate thermal evolution in the host rock approximated as a thermal conduction process to facilitate the analysis of design options. However, the assumptions and the properties (parameters) used in these models are different, which not only make inter-model comparisons difficult, but also compromise the applicability of the lessons learned from one model to another model. The establishment of a reference case would therefore be helpful to set up a baseline for model development. A generic salt repository reference case was developed in Freeze et al. (2013) and the generic argillite repository reference case is presented in this report. The definition of a reference case requires the characterization of the waste inventory, waste form, waste package, repository layout, EBS backfill, host rock, and biosphere. This report mainly documents the processes in EBS bentonite and host rock that are potentially important for performance assessment and properties that are needed to describe these processes, with brief description other components such as waste inventory, waste form, waste package, repository layout, aquifer, and biosphere. A thorough description of the generic argillite repository reference case will be given in Jové Colon et al. (2014).« less

Contribution of community health workers to surveillance of vaccine-preventable diseases in the Obala health district

PubMed Central

Vouking, Marius Zambou; Binde, Thierry; Tadenfok, Carine Nouboudem; Ekani, Jean Marie Edengue; Ekra, Daniel

2017-01-01

Introduction The establishment of effective community-based surveillance is an essential objective of all disease surveillance systems. Several studies and reports have found that the situation is far from optimal in several developing countries such as Cameroon. Methods We conducted a cross-sectional descriptive study to assess the contribution of community health workers to surveillance of vaccine-preventable diseases in Obala health district. The performance of community health workers was measured using: the number of cases referred to the health center, the percentage of accomplished referrals, the percentage of cases referred by community health workers confirmed by the staff of health centers. A questionnaire containing forty-seven questions (open-ended and closed-ended) was used for interviews with community health workers. The data were analyzed using SPSS 21 and Excel 2007. Counts and percentages are reported. Results The study showed that the age ranged of community health workers was from 24 to 61 years with an average of 37.9 years ± 6.7 years. The most represented age group was between 40 and 50 with a percentage of 38.6%. The male sex was more represented than the female sex (61.4% vs 38.6%) or a sex ratio male man of 1.7. Forty-five percent of community health workers were selected at a village meeting, 93.1% of community health workers were involved in the surveillance of vaccine-preventable diseases and 87% experienced at least one preventable disease. Only 45.8% of them had the case definitions of the four diseases. Analysis of community health workers attendance at organized health committee meetings showed that 79% of community health workers attended at least one health committee meeting in 2015 and only 49% were monitored in 2015. Community health workers reported 42 suspected cases of measles, 37 of which actually went to the nearest Health Center, a baseline rate of 88%. Conclusion Community health workers play a key role in the control of vaccine-preventable diseases in the Obala health district. Community-based surveillance is the foundation of surveillance activities. It is a mechanism based on simple case definitions of priority diseases and unexpected events or unusual conditions. Our study also reaffirms the importance of mastering case definitions and home visits and early detection of vaccine-preventable diseases. PMID:29610645

Business Process Modelling is an Essential Part of a Requirements Analysis. Contribution of EFMI Primary Care Working Group.

PubMed

de Lusignan, S; Krause, P; Michalakidis, G; Vicente, M Tristan; Thompson, S; McGilchrist, M; Sullivan, F; van Royen, P; Agreus, L; Desombre, T; Taweel, A; Delaney, B

2012-01-01

To perform a requirements analysis of the barriers to conducting research linking of primary care, genetic and cancer data. We extended our initial data-centric approach to include socio-cultural and business requirements. We created reference models of core data requirements common to most studies using unified modelling language (UML), dataflow diagrams (DFD) and business process modelling notation (BPMN). We conducted a stakeholder analysis and constructed DFD and UML diagrams for use cases based on simulated research studies. We used research output as a sensitivity analysis. Differences between the reference model and use cases identified study specific data requirements. The stakeholder analysis identified: tensions, changes in specification, some indifference from data providers and enthusiastic informaticians urging inclusion of socio-cultural context. We identified requirements to collect information at three levels: micro- data items, which need to be semantically interoperable, meso- the medical record and data extraction, and macro- the health system and socio-cultural issues. BPMN clarified complex business requirements among data providers and vendors; and additional geographical requirements for patients to be represented in both linked datasets. High quality research output was the norm for most repositories. Reference models provide high-level schemata of the core data requirements. However, business requirements' modelling identifies stakeholder issues and identifies what needs to be addressed to enable participation.

Endogenous steroid hormone levels in early pregnancy and risk of testicular cancer in the offspring: a nested case-referent study.

PubMed

Holl, Katsiaryna; Lundin, Eva; Surcel, Heljä-Marja; Grankvist, Kjell; Koskela, Pentti; Dillner, Joakim; Hallmans, Göran; Wadell, Göran; Olafsdottir, Gudridur H; Ogmundsdottir, Helga M; Pukkala, Eero; Lehtinen, Matti; Stattin, Pär; Lukanova, Annekatrin

2009-06-15

According to the leading hypothesis on testicular cancer (TC) etiology exposure to a specific pattern of steroid hormones in utero, in particular, to high levels of estrogens and low levels of androgens is the major determinant of TC risk in the offspring. We performed a case-referent study nested within Finnish, Swedish and Icelandic maternity cohorts exploiting early pregnancy serum samples to evaluate the role of maternal endogenous steroid hormones with regard to the risk of TC. TC cases and referents were aged between 0 and 25 years. For each case-index mother pair, three or four matched referent-referent mother pairs were identified using national population registries. First trimester or early second trimester sera were retrieved from the index mothers of 73 TC cases and 286 matched referent mothers, and were tested for dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone, estradiol, estrone, and sex hormone binding globulin (SHBG). Offspring of mothers with high DHEAS levels had a significantly decreased risk of TC (OR for highest vs. lowest DHEAS quartile, 0.18 (95% CI 0.06-0.58). In contrast, offspring of mothers with high androstenedione levels had an increased risk of TC (OR 4.1; 95% CI 1.2-12.0). High maternal total estradiol level also tended to be associated with an increased risk of TC in the offspring (OR 32; 95% CI 0.98-1,090). We report the first direct evidence that interplay of maternal steroid hormones in the early pregnancy is important in the etiology of TC in the offspring. Copyright 2008 UICC.

A value-based medicine comparison of interventions for subfoveal neovascular macular degeneration.

PubMed

Brown, Gary C; Brown, Melissa M; Brown, Heidi C; Kindermann, Sylvia; Sharma, Sanjay

2007-06-01

To perform a value-based medicine analysis of clinical trials that evaluate the interventions of laser photocoagulation, intravitreal pegaptanib therapy, and photodynamic therapy (PDT) with verteporfin for the treatment of classic subfoveal choroidal neovascularization. Reference case cost-utility analysis using value-based medicine principles, which use patient-based utility values and standardized, input variable criteria. Data from participants in the Macular Photocoagulation Study, Pegaptanib for Neovascular Age-Related Macular Degeneration Study, and the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study. Visual data were converted to a value-based format using time tradeoff utility analysis values from patients with macular degeneration. Costs were obtained from 2005 Medicare data. Outcomes (quality-adjusted life-years [QALYs]) and costs were discounted at a 3% annual rate. Interventional QALYs gained, percent improvement in quality of life, and dollars spent per QALY gained. Laser photocoagulation confers a 4.4% (P = 0.03 versus pegaptanib therapy) improvement in quality of life for the reference case, whereas pegaptanib therapy confers a 5.9% improvement and PDT confers an 8.1% (P = 0.0002 versus pegaptanib therapy) improvement. The cost-utility associated with laser photocoagulation is $8179, that for pegaptanib therapy is $66978, and that for PDT is $31544. All sensitivity analyses remain within the conventional standards of cost-effectiveness. Photodynamic therapy confers greater patient value than intravitreal pegaptanib therapy and laser photocoagulation for the treatment of classic subfoveal choroidal neovascularization. Despite the fact that laser photocoagulation is the most cost-effective intervention, both PDT and pegaptanib therapy deliver greater value, and thus are both preferred over laser photocoagulation. Using an economic measure, photodynamic therapy is the preferred treatment among these 3 interventions.

[Based on the incidence of Creutzfeldt-Jakob disease in the Lanzarote healthcare area. Description of two definitive cases].

PubMed

Hernández-Ramos, F J; Martínez Martín, M; Esteban Robayna, M; Jensen Toll, F; Palacios Llopis, S

2005-01-01

We present two cases who have been diagnosed of definitive Creutzfeldt-Jakob disease in the health area of Lanzarote in the period January 2002 to January 2004. The two cases are presented with clinical description, complementary tests -- including electroencephalogram, 14-3-3 protein determination -- study of the prionic protein gene, and histopathologic findings. In this article, we try to show the importance of trying to reach a definitive diagnosis with the histopathologic study once there is clinical suspicion (a diagnosis that is probable or possible). In addition our cases show that communication between the clinical and the epidemiological coordinator of the regional community and the National Center of Epidemiology is very important. We refer to the clear growth in the incidence of the disease in the population of Lanzarote in the period above mentioned. Finally, we discuss whether this growth is or is not an isolated event.

Dutch Dataset Pain Rehabilitation in daily practice: Content, patient characteristics and reference data.

PubMed

Köke, A J A; Smeets, R J E M; Schreurs, K M; van Baalen, B; de Haan, P; Remerie, S C; Schiphorst Preuper, H R; Reneman, M F

2017-03-01

No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. The Dutch Dataset Pain Rehabilitation was developed which included the six domains of the IMMPACT core set and three new domains relevant in the field of rehabilitation (medical consumption, patient-specific goals and activities/participation). Between 2010 and 2013 the core set was implemented in 32 rehabilitation facilities throughout the Netherlands. A total of 8200 adult patients with chronic pain completed the core set at first consultation with the rehabilitation physician. Adult patients (18-90 years) suffering from a long history of pain (38% >5 years) were referred. Patients had high medical consumption and less than half were working. Although patients were referred with diagnosis of low back pain or neck or shoulder pain, a large group (85%) had multisite pain (39% 2-5 painful body regions; 46% >5 painful body regions). Scores on psychosocial questionnaires were high, indicating high case complexity of referred patients. Reference data for subgroups based on gender, pain severity, pain locations and on pain duration are presented. The data from this clinical core set can be used to compare patient characteristics of patients of other treatment setting and/or scientific publications. As treatment success might depend on case complexity, which is high in the referred patients, the advantages of earlier referral to comprehensive multidisciplinary treatment were discussed. A detailed description of case complexity of patients with chronic pain referred for pain rehabilitation. Insight in case complexity of patients within subgroups on the basis of gender, pain duration, pain severity and pain location. These descriptions can be used as reference data for daily practice in the field of pain rehabilitation and can be used to evaluate, monitor and improve rehabilitation care in care settings nationwide as well as internationally. © 2016 European Pain Federation - EFIC®.

Prayer Healing: A Case Study Research Protocol.

PubMed

Kruijthoff, Dirk J; van der Kooi, Cornelis; Glas, Gerrit; Abma, Tineke A

2017-01-01

Context • Prayer healing is a common practice in many religious communities around the world. Even in the highly secularized Dutch society, cases of prayer healing are occasionally reported in the media, often generating public attention. There is an ongoing debate regarding whether such miraculous cures do actually occur and how to interpret them. Objective • The aim of the article was to present a research protocol for the investigation of reported cases of remarkable and/or unexplained healing after prayer. Design • The research team developed a method to perform a retrospective, case-based study of prayer healing. Reported prayer healings can be investigated systematically in accordance with a step-by-step methodology. The focus is on understanding the healing by studying it from multiple perspectives, using both medical judgment and patients' narratives collected by qualitative methods Setting • The study occurred at Vrije Universiteit (VU) and VU Medical Center (Amsterdam, Netherlands) as well as the general medical practice of the first author. Participants • Potential participants could be any individuals in the Netherlands or neighboring countries who claim to have been healed through prayer. The reports of healing came from multiple sources, including the research team's medical practices and their direct vicinities, newspaper articles, prayer healers, and medical colleagues. Outcome Measures • Medical data were obtained before and after prayer. Subsequently, a member of a research team and of a medical assessment committee made a standardized judgment that evaluated whether a cure was clinically remarkable or scientifically unexplained. The participants' experiences and insider perspectives were studied, using in-depth interviews in accordance with a qualitative research methodology, to gain insight into the perceptions and explanations of the cures that were offered by participants and by the members of the medical assessment committee. The medical findings and participants' experiences were weighed and interpreted based on a transdisciplinary framework, including biopsychosocial and theological perspectives, with reference to a conceptual framework derived from Ian Barbour's typology of positions in the science-religion debate. Conclusion • A case-based, research study protocol that compares medical and experiential findings and that interprets and structures those findings with reference to Ian Barbour's conceptual model is an innovative way of gaining deeper insight into the nature of remarkable and/or unexplained cures.

Attrition, occlusion, (dys)function, and intervention: a systematic review.

PubMed

van 't Spijker, Arie; Kreulen, Cees M; Creugers, Nico H J

2007-06-01

Attrition and occlusal factors and masticatory function or dysfunction are thought to be related. This study aims to systematically review the literature on this topic with the emphasis to find evidence for occlusion-based treatment protocols for attrition. Literature was searched using PubMed (1980 to 2/2006) and the Cochrane Library of Clinical Trials with the keywords 'tooth' and 'wear'. Five steps were followed. Exclusion was based on the following: (1) reviews, case-reports, studies on non-human tooth material, and studies not published in English and (2) historical or forensic studies. Included were (3) in vivo studies. Next, studies on (4) occlusal factors, function or dysfunction [temporomandibular disorders (TMD), bruxism], or intervention, and (5) attrition were included. Two investigators independently assessed the abstracts; measure of agreement was calculated using Cohen's kappa; disagreement was resolved by discussion. Full-text articles were obtained and correlation between outcomes on occlusal factors, (dys)function, treatment, and attrition were retrieved. References in the papers included in the final analysis were cross-matched with the original list of references to add references that met the inclusion criteria. The search procedure revealed 1289 references on tooth wear. The numbers of included studies after each step were (1) 345 (kappa=0.8), (2) 287 (kappa=0.87), (3) 174 (kappa=0.99), (4) 81 (kappa=0.71), and (5) 27 (kappa=0.68). Hand searches through the reference lists revealed six additional papers to be included. Analysis of the 33 included papers failed to find sound evidence for recommending a certain occlusion-based treatment protocol above another in the management of attrition. Some studies reported correlations between attrition and anterior spatial relationships. No studies were found suggesting that absent posterior support necessarily leads to increased attrition, though one study found that fewer number of teeth resulted in higher tooth wear index (on the remaining teeth). Attrition seems to be co-existent with self-reported bruxism. Reports on attrition and TMD signs and symptoms provide little understanding of the relationship between the two.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koponen, Kati; Soimakallio, Sampo; Kline, Keith L.

In order to understand the climate effects of a bioenergy system, a comparison between the bioenergy system and a reference system is required. The reference system describes the situation that occurs in the absence of the bioenergy system with respect to the use of land, energy, and materials. The importance of reference systems is discussed in the literature but guidance on choosing suitable reference systems for assessing climate effects of bioenergy is limited. The reference system should align with the purpose of the study. Transparency of reference system assumptions is essential for proper interpretation of bioenergy assessments. This paper presentsmore » guidance for selecting suitable reference systems. Particular attention is given to choosing the land reference. If the goal is to study the climate effects of bioenergy as a part of total anthropogenic activity the reference system should illustrate what is expected in the absence of human activities. In such a case the suitable land reference is natural regeneration, and energy or material reference systems are not relevant. If the goal is to assess the effect of a change in bioenergy use, the reference system should incorporate human activities. In this case suitable reference systems describe the most likely alternative uses of the land, energy and materials in the absence of the change in bioenergy use. The definition of the reference system is furthermore subject to the temporal scope of the study. In practice, selecting and characterizing reference systems will involve various choices and uncertainties which should be considered carefully. As a result, it can be instructive to consider how alternative reference systems influence the results and conclusions drawn from bioenergy assessments.« less

Acute thoracolumbar pain due to cholecystitis: a case study.

PubMed

Carter, Chris T

2015-01-01

This article describes and discusses the case of an adult female with cholecystitis characterized on initial presentation as acute thoracolumbar pain. A 34-year-old female presented for care with a complaint of acute right sided lower thoracic and upper lumbar pain with associated significant hyperalgesia and muscular hypertonicity. The patient was examined, referred, and later diagnosed by use of ultrasound imaging. Despite many initial physical examination findings of musculoskeletal dysfunction, this case demonstrates the significance of visceral referred pain, viscerosomatic hyperalgesia & hypertonicity, and how these neurological processes can mimic mechanical pain syndromes. A clinical neurological discussion of cholecystitis visceral pain and referred viscerosomatic phenomena is included.

Ecological quality boundary-setting procedures: the Gulf of Riga case study.

PubMed

Aigars, Juris; Müller-Karulis, Bärbel; Martin, Georg; Jermakovs, Vadims

2008-03-01

Two approaches for setting ecological class boundaries, response curves and a simplified mathematical boundary-setting protocol, were tested for coastal, transitional and open waters in the Gulf of Riga, Baltic Sea. The simplified mathematical boundary-setting protocol defines acceptable ecological status based on expert judgment by a uniform relative deviation from reference conditions. In contrast, response curves derive class boundary definitions from observed changes in biological quality elements along environmental pressure gradients for class boundary definitions. Identification of relevant environmental pressures for the construction of response curves was based on a conceptual model of eutrophication in the Gulf of Riga. Response curves were successfully established for summer chlorophyll a and transparency, as well as for macrozoobenthos abundance in the Central Gulf, macrozoobenthos biotic coefficient in the Southern Gulf, and maximum depth of phytobenthos in the Northern Gulf. In the Gulf of Riga response curves almost always permitted a larger deviation from reference conditions than the 50% deviation applied for the simplified mathematical boundary-setting protocol. The case study clearly demonstrated that class boundary definitions should take into account the sensitivity of the target water body. Also, the class boundaries for different ecological quality elements were internally more consistent than those derived by the simplified mathematical boundary-setting protocol.

Acute otalgia in Nigerian children.

PubMed

Ijaduola, T G

1985-12-01

A study of 112 referred children with acute otalgia labeled 'acute otitis media' by the referring physicians was carried out at the E.N.T. clinic of Lagos University Teaching Hospital in 1981-1982. Only 11% of these were actually due to acute otitis media, reflecting poor technique at otoscopy. Of the acute otalgia cases 56% were due to ear pathology while 44% resulted from referred pain. Otological causes included foreign body in the ear (23%), acute otitis media (11%), otitis externa (10%), secretory otitis media (6%) and myringitis bullosa haemorrhagica (4%). Cases due to referred otalgia were from tonsillitis (21%), foreign body in the pharynx (5%), traditional uvulectomy (5%), and foreign body in the nose (2%). Thus, there is a need for more careful examination of the ear in all cases of acute otalgia.

Topology of the Relative Motion: Circular and Eccentric Reference Orbit Cases

NASA Technical Reports Server (NTRS)

FontdecabaiBaig, Jordi; Metris, Gilles; Exertier, Pierre

2007-01-01

This paper deals with the topology of the relative trajectories in flight formations. The purpose is to study the different types of relative trajectories, their degrees of freedom, and to give an adapted parameterization. The paper also deals with the research of local circular motions. Even if they exist only when the reference orbit is circular, we extrapolate initial conditions to the eccentric reference orbit case.This alternative approach is complementary with traditional approaches in terms of cartesian coordinates or differences of orbital elements.

Towards generalised reference condition models for environmental assessment: a case study on rivers in Atlantic Canada.

PubMed

Armanini, D G; Monk, W A; Carter, L; Cote, D; Baird, D J

2013-08-01

Evaluation of the ecological status of river sites in Canada is supported by building models using the reference condition approach. However, geography, data scarcity and inter-operability constraints have frustrated attempts to monitor national-scale status and trends. This issue is particularly true in Atlantic Canada, where no ecological assessment system is currently available. Here, we present a reference condition model based on the River Invertebrate Prediction and Classification System approach with regional-scale applicability. To achieve this, we used biological monitoring data collected from wadeable streams across Atlantic Canada together with freely available, nationally consistent geographic information system (GIS) environmental data layers. For the first time, we demonstrated that it is possible to use data generated from different studies, even when collected using different sampling methods, to generate a robust predictive model. This model was successfully generated and tested using GIS-based rather than local habitat variables and showed improved performance when compared to a null model. In addition, ecological quality ratio data derived from the model responded to observed stressors in a test dataset. Implications for future large-scale implementation of river biomonitoring using a standardised approach with global application are presented.

Towards a framework for developing semantic relatedness reference standards.

PubMed

Pakhomov, Serguei V S; Pedersen, Ted; McInnes, Bridget; Melton, Genevieve B; Ruggieri, Alexander; Chute, Christopher G

2011-04-01

Our objective is to develop a framework for creating reference standards for functional testing of computerized measures of semantic relatedness. Currently, research on computerized approaches to semantic relatedness between biomedical concepts relies on reference standards created for specific purposes using a variety of methods for their analysis. In most cases, these reference standards are not publicly available and the published information provided in manuscripts that evaluate computerized semantic relatedness measurement approaches is not sufficient to reproduce the results. Our proposed framework is based on the experiences of medical informatics and computational linguistics communities and addresses practical and theoretical issues with creating reference standards for semantic relatedness. We demonstrate the use of the framework on a pilot set of 101 medical term pairs rated for semantic relatedness by 13 medical coding experts. While the reliability of this particular reference standard is in the "moderate" range; we show that using clustering and factor analyses offers a data-driven approach to finding systematic differences among raters and identifying groups of potential outliers. We test two ontology-based measures of relatedness and provide both the reference standard containing individual ratings and the R program used to analyze the ratings as open-source. Currently, these resources are intended to be used to reproduce and compare results of studies involving computerized measures of semantic relatedness. Our framework may be extended to the development of reference standards in other research areas in medical informatics including automatic classification, information retrieval from medical records and vocabulary/ontology development. Copyright © 2010 Elsevier Inc. All rights reserved.

Reference set for performance testing of pediatric vaccine safety signal detection methods and systems.

PubMed

Brauchli Pernus, Yolanda; Nan, Cassandra; Verstraeten, Thomas; Pedenko, Mariia; Osokogu, Osemeke U; Weibel, Daniel; Sturkenboom, Miriam; Bonhoeffer, Jan

2016-12-12

Safety signal detection in spontaneous reporting system databases and electronic healthcare records is key to detection of previously unknown adverse events following immunization. Various statistical methods for signal detection in these different datasources have been developed, however none are geared to the pediatric population and none specifically to vaccines. A reference set comprising pediatric vaccine-adverse event pairs is required for reliable performance testing of statistical methods within and across data sources. The study was conducted within the context of the Global Research in Paediatrics (GRiP) project, as part of the seventh framework programme (FP7) of the European Commission. Criteria for the selection of vaccines considered in the reference set were routine and global use in the pediatric population. Adverse events were primarily selected based on importance. Outcome based systematic literature searches were performed for all identified vaccine-adverse event pairs and complemented by expert committee reports, evidence based decision support systems (e.g. Micromedex), and summaries of product characteristics. Classification into positive (PC) and negative control (NC) pairs was performed by two independent reviewers according to a pre-defined algorithm and discussed for consensus in case of disagreement. We selected 13 vaccines and 14 adverse events to be included in the reference set. From a total of 182 vaccine-adverse event pairs, we classified 18 as PC, 113 as NC and 51 as unclassifiable. Most classifications (91) were based on literature review, 45 were based on expert committee reports, and for 46 vaccine-adverse event pairs, an underlying pathomechanism was not plausible classifying the association as NC. A reference set of vaccine-adverse event pairs was developed. We propose its use for comparing signal detection methods and systems in the pediatric population. Published by Elsevier Ltd.

Mathematical Practice in Textbooks Analysis: Praxeological Reference Models, the Case of Proportion

ERIC Educational Resources Information Center

Wijayanti, Dyana; Winsløw, Carl

2017-01-01

We present a new method in textbook analysis, based on so-called praxeological reference models focused on specific content at task level. This method implies that the mathematical contents of a textbook (or textbook part) is analyzed in terms of the tasks and techniques which are exposed to or demanded from readers; this can then be interpreted…

[The IARC carcinogenicity evaluation of radio-frequency electromagnetic field: with special reference to epidemiology of mobile phone use and brain tumor risk].

PubMed

Yamaguchi, Naohito

2013-01-01

The International Agency for Research on Cancer of World Health Organization announced in May 2011 the results of evaluation of carcinogenicity of radio-frequency electromagnetic field. In the overall evaluation, the radio-frequency electromagnetic field was classified as "possibly carcinogenic to humans", on the basis of the fact that the evidence provided by epidemiological studies and animal bioassays was limited. Regarding epidemiology, the results of the Interphone Study, an international collaborative case-control study, were of special importance, together with the results of a prospective cohort study in Denmark, case-control studies in several countries, and a case-case study in Japan. The evidence obtained was considered limited, because the increased risk observed in some studies was possibly spurious, caused by selection bias or recall bias as well as residual effects of confounding factors. Further research studies, such as large-scale multinational epidemiological studies, are crucially needed to establish a sound evidence base from which a more conclusive judgment can be made for the carcinogenicity of the radio-frequency electromagnetic field.

7 CFR 1.626 - What regulations apply to a case referred for a hearing?

Code of Federal Regulations, 2014 CFR

2014-01-01

... referred for a hearing? (a) If NFS refers the case to OALJ, these regulations will continue to apply to the hearing process. (b) If NFS refers the case to the Department of the Interior's Office of Hearing and Appeals, the regulations at 43 CFR 45.1 et seq. will apply from that point. (c) If NFS refers the case to...

7 CFR 1.626 - What regulations apply to a case referred for a hearing?

Code of Federal Regulations, 2013 CFR

2013-01-01

... referred for a hearing? (a) If NFS refers the case to OALJ, these regulations will continue to apply to the hearing process. (b) If NFS refers the case to the Department of the Interior's Office of Hearing and Appeals, the regulations at 43 CFR 45.1 et seq. will apply from that point. (c) If NFS refers the case to...

7 CFR 1.626 - What regulations apply to a case referred for a hearing?

Code of Federal Regulations, 2012 CFR

2012-01-01

... referred for a hearing? (a) If NFS refers the case to OALJ, these regulations will continue to apply to the hearing process. (b) If NFS refers the case to the Department of the Interior's Office of Hearing and Appeals, the regulations at 43 CFR 45.1 et seq. will apply from that point. (c) If NFS refers the case to...

7 CFR 1.626 - What regulations apply to a case referred for a hearing?

Code of Federal Regulations, 2011 CFR

2011-01-01

... referred for a hearing? (a) If NFS refers the case to OALJ, these regulations will continue to apply to the hearing process. (b) If NFS refers the case to the Department of the Interior's Office of Hearing and Appeals, the regulations at 43 CFR 45.1 et seq. will apply from that point. (c) If NFS refers the case to...

7 CFR 1.626 - What regulations apply to a case referred for a hearing?

Code of Federal Regulations, 2010 CFR

2010-01-01

... referred for a hearing? (a) If NFS refers the case to OALJ, these regulations will continue to apply to the hearing process. (b) If NFS refers the case to the Department of the Interior's Office of Hearing and Appeals, the regulations at 43 CFR 45.1 et seq. will apply from that point. (c) If NFS refers the case to...

Reference Assessment

ERIC Educational Resources Information Center

Bivens-Tatum, Wayne

2006-01-01

This article presents interesting articles that explore several different areas of reference assessment, including practical case studies and theoretical articles that address a range of issues such as librarian behavior, patron satisfaction, virtual reference, or evaluation design. They include: (1) "Evaluating the Quality of a Chat Service"…

Problem-based learning in the NICU.

PubMed

Pilcher, Jobeth

2014-01-01

Problem-based learning (PBL) is an educational strategy that provides learners with the opportunity to investigate and solve realistic problem situations. It is also referred to as project-based learning or work-based learning. PBL combines several learning strategies including the use of case studies coupled with collaborative, facilitated, and self-directed learning. Research has demonstrated that use of PBL can result in learners having improved problem-solving skills, increased breadth and analysis of complex data, higher-level thinking skills, and improved collaboration. This article will include background information and a description of PBL, followed by examples of how this strategy can be used for learning in neonatal settings.

Specificity of the links between workplace harassment and PTSD: primary results using court decisions, a pilot study in France.

PubMed

Bonafons, Claire; Jehel, Louis; Coroller-Béquet, Alain

2009-04-01

France is one of the first countries to have passed specific legislation concerning "mental harassment" (In French the term used in the legislation is "harcèlement moral" referring to harassment or bullying leading to mental or psychological distress.) in the workplace. However, the definition of mental harassment at work remains fairly vague. It is, indeed, a complex issue, since no objective and precise consensual definition has been given so far. The objective of this study is to clarify the criteria that French judges consider as characteristic of mental harassment, and to check whether the specific links between mental harassment at work and PTSD pointed to in recent international studies have been taken into account. This study proposes the main lines for debate in countries that have not yet adopted legal clauses on mental harassment at work. Our study is based on a sample of 22 people who were legally recognised as having been mentally harassed at work; this sample is taken as representative of all court decisions passed on harassment and published as such on the French Ministry of Justice website. To establish whether they were considering a case of harassment, the judges based their decisions on the nature of the accusations. In all cases (22/22), the charges brought against the defendant had to do with offences against the employee's dignity. Five cases out of 22 dealt with an offence infringing their rights, 10 cases out of 22 related to the employee's future within the company being compromised, while half of the cases (11/22) concerned a deterioration in the person's health. In more than half of the cases, the judges also looked for other factors, such as repetition and duration of the period of harassment. Whenever the judges noted a deterioration in the victim's mental health, they also referred to medical certificates reporting anxio-depressive syndromes or psychological disorders without providing further detail. No PTSD-like symptomatology was mentioned among these cases, although several studies have shown that many victims of mental harassment at work have specific symptoms of PTSD. This study is the first study to be carried out on mental harassment at work and to refer to court decisions since the law was promulgated in France (2002). It appears that, in order to be recognised as a victim of mental harassment at work, numerous proofs of harassment or bullying need to be produced. It must have been repeated and have led to consequences in several domains. Several attestations and documents are required demonstrating clearly that harassment or bullying did indeed occur. Further to this, although to date judges have not considered PTSD to be an element contributing to the presumption of harassment, connections between bullying or harassment and clinical signs of PTSD have been attested by several studies that confirm that bullied victims can suffer from PTSD-like symptoms, although they do not necessarily match the strict DSM-IV criteria (absence of A1 criterion). It would seem advisable to request psychiatric examination in cases of harassment.

A clustering method of Chinese medicine prescriptions based on modified firefly algorithm.

PubMed

Yuan, Feng; Liu, Hong; Chen, Shou-Qiang; Xu, Liang

2016-12-01

This paper is aimed to study the clustering method for Chinese medicine (CM) medical cases. The traditional K-means clustering algorithm had shortcomings such as dependence of results on the selection of initial value, trapping in local optimum when processing prescriptions form CM medical cases. Therefore, a new clustering method based on the collaboration of firefly algorithm and simulated annealing algorithm was proposed. This algorithm dynamically determined the iteration of firefly algorithm and simulates sampling of annealing algorithm by fitness changes, and increased the diversity of swarm through expansion of the scope of the sudden jump, thereby effectively avoiding premature problem. The results from confirmatory experiments for CM medical cases suggested that, comparing with traditional K-means clustering algorithms, this method was greatly improved in the individual diversity and the obtained clustering results, the computing results from this method had a certain reference value for cluster analysis on CM prescriptions.

Morbidity and Mortality Conference in Obstetrics and Gynecology: A Tool for Addressing the 6 Core Competencies

PubMed Central

Bevis, Kerri S; Straughn, J. Michael; Kendrick, James E; Walsh-Covarrubias, Julie; Kilgore, Larry C

2011-01-01

Background Residency program directors are challenged to effectively teach and assess the Accreditation Council for Graduate Medical Education's (ACGME) 6 competencies. The purpose of this study was to characterize the morbidity and mortality (M&M) conference as a cost-effective and efficient approach for addressing the ACGME competencies through evaluation of resident participation and case diversity. Methods In our modified M&M conference, senior residents submit a weekly list of cases to the conference proctors. The resident presents the case, including a critique of management, using the medical literature. The resident submits a case summary evaluating patient care practices, integrating scientific evidence, and evaluating systemic barriers to care. Completed case summaries are distributed and archived for reference. Results During a 3-year period, 30 residents presented 196 cases. Of these, 37 (19%) directly related to systems-based practice, 20 (10%) involved problems with inadequate communication, and 11 (6%) included issues of professionalism or ethics. All cases involved practice-based learning and medical knowledge. Conclusions The M&M conference addresses the core competencies through resident participation as well as directed analysis of diverse cases. PMID:22379530

Safety of audiology direct access for medicare patients complaining of impaired hearing.

PubMed

Zapala, David A; Stamper, Greta C; Shelfer, Janet S; Walker, David A; Karatayli-Ozgursoy, Selmin; Ozgursoy, Ozan B; Hawkins, David B

2010-06-01

Allowing Medicare beneficiaries to self-refer to audiologists for evaluation of hearing loss has been advocated as a cost-effective service delivery model. Resistance to audiology direct access is based, in part, on the concern that audiologists might miss significant otologic conditions. To evaluate the relative safety of audiology direct access by comparing the treatment plans of audiologists and otolaryngologists in a large group of Medicare-eligible patients seeking hearing evaluation. Retrospective chart review study comparing assessment and treatment plans developed by audiologists and otolaryngologists. 1550 records comprising all Medicare eligible patients referred to the Audiology Section of the Mayo Clinic Florida in 2007 with a primary complaint of hearing impairment. Assessment and treatment plans were compiled from the electronic medical record and placed in a secured database. Records of patients seen jointly by audiology and otolaryngology practitioners (Group 1: 352 cases) were reviewed by four blinded reviewers, two otolaryngologists and two audiologists, who judged whether the audiologist treatment plan, if followed, would have missed conditions identified and addressed in the otolaryngologist's treatment plan. Records of patients seen by audiology but not otolaryngology (Group 2: 1198 cases) were evaluated by a neurotologist who judged whether the patient should have seen an otolaryngologist based on the audiologist's documentation and test results. Additionally, the audiologist and reviewing neurotologist judgments about hearing asymmetry were compared to two mathematical measures of hearing asymmetry (Charing Cross and AAO-HNS [American Academy of Otolaryngology-Head and Neck Surgery] calculations). In the analysis of Group 1 records, the jury of four judges found no audiology discrepant treatment plans in over 95% of cases. In no case where a judge identified a discrepancy in treatment plans did the audiologist plan risk missing conditions associated with significant mortality or morbidity that were subsequently identified by the otolaryngologist. In the analysis of Group 2 records, the neurotologist judged that audiology services alone were all that was required in 78% of cases. An additional 9% of cases were referred for subsequent medical evaluation. The majority of remaining patients had hearing asymmetries. Some were evaluated by otolaryngology for hearing asymmetry in the past with no interval changes, and others were consistent with noise exposure history. In 0.33% of cases, unexplained hearing asymmetry was potentially missed by the audiologist. Audiologists and the neurotologist demonstrated comparable accuracy in identifying Charing Cross and AAO-HNS pure-tone asymmetries. Of study patients evaluated for hearing problems in the one-year period of this study, the majority (95%) ultimately required audiological services, and in most of these cases, audiological services were the only hearing health-care services that were needed. Audiologist treatment plans did not differ substantially from otolaryngologist plans for the same condition; there was no convincing evidence that audiologists missed significant symptoms of otologic disease; and there was strong evidence that audiologists referred to otolaryngology when appropriate. These findings are consistent with the premise that audiology direct access would not pose a safety risk to Medicare beneficiaries complaining of hearing impairment. American Academy of Audiology.

Mental health epidemiological research in South America: recent findings

PubMed Central

Silva de Lima, Maurício; Garcia de Oliveira Soares, Bernardo; de Jesus Mari, Jair

2004-01-01

This paper aims to review the recent mental health epidemiological research conducted in South America. The Latin American and the Caribbean (LILACS) database was searched from 1999 to 2003 using a specific strategy for identification of cohort, case-control and cross-sectional population-based studies in South America. The authors screened references and identified relevant studies. Further studies were obtained contacting local experts in epidemiology. 140 references were identified, and 12 studies were selected. Most selected studies explored the prevalence and risk factors for common mental disorders, and several of them used sophisticated methods of sample selection and analysis. There is a need for improving the quality of psychiatric journals in Latin America, and for increasing the distribution and access to research data. Regionally relevant problems such as violence and substance abuse should be considered in designing future investigations in this area. PMID:16633474

Differential gene expression in the siphonophore Nanomia bijuga (Cnidaria) assessed with multiple next-generation sequencing workflows.

PubMed

Siebert, Stefan; Robinson, Mark D; Tintori, Sophia C; Goetz, Freya; Helm, Rebecca R; Smith, Stephen A; Shaner, Nathan; Haddock, Steven H D; Dunn, Casey W

2011-01-01

We investigated differential gene expression between functionally specialized feeding polyps and swimming medusae in the siphonophore Nanomia bijuga (Cnidaria) with a hybrid long-read/short-read sequencing strategy. We assembled a set of partial gene reference sequences from long-read data (Roche 454), and generated short-read sequences from replicated tissue samples that were mapped to the references to quantify expression. We collected and compared expression data with three short-read expression workflows that differ in sample preparation, sequencing technology, and mapping tools. These workflows were Illumina mRNA-Seq, which generates sequence reads from random locations along each transcript, and two tag-based approaches, SOLiD SAGE and Helicos DGE, which generate reads from particular tag sites. Differences in expression results across workflows were mostly due to the differential impact of missing data in the partial reference sequences. When all 454-derived gene reference sequences were considered, Illumina mRNA-Seq detected more than twice as many differentially expressed (DE) reference sequences as the tag-based workflows. This discrepancy was largely due to missing tag sites in the partial reference that led to false negatives in the tag-based workflows. When only the subset of reference sequences that unambiguously have tag sites was considered, we found broad congruence across workflows, and they all identified a similar set of DE sequences. Our results are promising in several regards for gene expression studies in non-model organisms. First, we demonstrate that a hybrid long-read/short-read sequencing strategy is an effective way to collect gene expression data when an annotated genome sequence is not available. Second, our replicated sampling indicates that expression profiles are highly consistent across field-collected animals in this case. Third, the impacts of partial reference sequences on the ability to detect DE can be mitigated through workflow choice and deeper reference sequencing.

Differential Gene Expression in the Siphonophore Nanomia bijuga (Cnidaria) Assessed with Multiple Next-Generation Sequencing Workflows

PubMed Central

Siebert, Stefan; Robinson, Mark D.; Tintori, Sophia C.; Goetz, Freya; Helm, Rebecca R.; Smith, Stephen A.; Shaner, Nathan; Haddock, Steven H. D.; Dunn, Casey W.

2011-01-01

We investigated differential gene expression between functionally specialized feeding polyps and swimming medusae in the siphonophore Nanomia bijuga (Cnidaria) with a hybrid long-read/short-read sequencing strategy. We assembled a set of partial gene reference sequences from long-read data (Roche 454), and generated short-read sequences from replicated tissue samples that were mapped to the references to quantify expression. We collected and compared expression data with three short-read expression workflows that differ in sample preparation, sequencing technology, and mapping tools. These workflows were Illumina mRNA-Seq, which generates sequence reads from random locations along each transcript, and two tag-based approaches, SOLiD SAGE and Helicos DGE, which generate reads from particular tag sites. Differences in expression results across workflows were mostly due to the differential impact of missing data in the partial reference sequences. When all 454-derived gene reference sequences were considered, Illumina mRNA-Seq detected more than twice as many differentially expressed (DE) reference sequences as the tag-based workflows. This discrepancy was largely due to missing tag sites in the partial reference that led to false negatives in the tag-based workflows. When only the subset of reference sequences that unambiguously have tag sites was considered, we found broad congruence across workflows, and they all identified a similar set of DE sequences. Our results are promising in several regards for gene expression studies in non-model organisms. First, we demonstrate that a hybrid long-read/short-read sequencing strategy is an effective way to collect gene expression data when an annotated genome sequence is not available. Second, our replicated sampling indicates that expression profiles are highly consistent across field-collected animals in this case. Third, the impacts of partial reference sequences on the ability to detect DE can be mitigated through workflow choice and deeper reference sequencing. PMID:21829563

Mortality and Causes of Death in Patients With Osteogenesis Imperfecta: A Register-Based Nationwide Cohort Study.

PubMed

Folkestad, Lars; Hald, Jannie Dahl; Canudas-Romo, Vladimir; Gram, Jeppe; Hermann, Anne Pernille; Langdahl, Bente; Abrahamsen, Bo; Brixen, Kim

2016-12-01

Osteogenesis imperfecta (OI) is a hereditary connective tissue disease that causes frequent fractures. Little is known about causes of death and length of survival in OI. The objective of this work was to calculate the risk and cause of death, and the median survival time in patients with OI. This study was a Danish nationwide, population-based and register-based cohort study. We used National Patient Register data from 1977 until 2013 with complete long-term follow-up. Participants comprised all patients registered with the diagnosis of OI from 1977 until 2013, and a reference population matched five to one to the OI cohort. We calculated hazard ratios for all-cause mortality and subhazard ratios for cause-specific mortality in a comparison of the OI cohort and the reference population. We also calculated all-cause mortality hazard ratios for males, females, and age groups (0 to 17.99 years, 18.00 to 34.99 years, 35.00 to 54.99 years, 55.00 to 74.99 years, and >75 years). We identified 687 cases of OI (379 women) and included 3435 reference persons (1895 women). A total of 112 patients with OI and 257 persons in the reference population died during the observation period. The all-cause mortality hazard ratio between the OI cohort and the reference population was 2.90. The median survival time for males with OI was 72.4 years, compared to 81.9 in the reference population. The median survival time for females with OI was 77.4 years, compared to 84.5 years in the reference population. Patients with OI had a higher risk of death from respiratory diseases, gastrointestinal diseases, and trauma. We were limited by the lack of clinical information about phenotype and genotype of the included patients. Patients with OI had a higher mortality rate throughout their life compared to the general population. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and Mineral Research.

Using an Ishikawa diagram as a tool to assist memory and retrieval of relevant medical cases from the medical literature.

PubMed

Wong, Kam Cheong

2011-03-29

Studying medical cases is an effective way to enhance clinical reasoning skills and reinforce clinical knowledge. An Ishikawa diagram, also known as a cause-and-effect diagram or fishbone diagram, is often used in quality management in manufacturing industries.In this report, an Ishikawa diagram is used to demonstrate how to relate potential causes of a major presenting problem in a clinical setting. This tool can be used by teams in problem-based learning or in self-directed learning settings.An Ishikawa diagram annotated with references to relevant medical cases and literature can be continually updated and can assist memory and retrieval of relevant medical cases and literature. It could also be used to cultivate a lifelong learning habit in medical professionals.

Validation of Reference Genes in mRNA Expression Analysis Applied to the Study of Asthma.

PubMed

Segundo-Val, Ignacio San; Sanz-Lozano, Catalina S

2016-01-01

The quantitative Polymerase Chain Reaction is the most used technique for the study of gene expression. To correct putative experimental errors of this technique is necessary normalizing the expression results of the gene of interest with the obtained for reference genes. Here, we describe an example of the process to select reference genes. In this particular case, we select reference genes for expression studies in the peripheral blood mononuclear cells of asthmatic patients.

Low hospital referral rates of school scoliosis screening positives in an urban district of mainland China.

PubMed

Guo, Yawen; Jiang, Qingwu; Tanimoto, Tetsuya; Kami, Masahiro; Luo, Chunyan; Leppold, Claire; Nishimura, Koichi; He, Yongpin; Kato, Shigeaki; Ding, Xiaocang

2017-04-01

Significant prevalence rates of adolescent scoliosis in China were suggested in previous studies. However, school screenings for adolescent scoliosis have been suspended due to low rates of positive detection under the past screening system in China. The present study was undertaken to screen for adolescent scoliosis in middle school students under a modern assessment system in a district of Shanghai. We performed a population-based, cross-sectional study of a middle school scoliosis screening program in the Jingan district. In 2015, schoolchildren were initially screened by visual inspection of clinical signs and the forward-bending test. Suspected cases were referred for radiography in hospital for scoliosis diagnosis. A total of 5327 middle school students (grades 6-8) were screened with 520 (9.76%) positives (the positive rates of girls and boys at 15.28% and 4.59%, respectively) and no statistically significant difference among grades. Only 301 positives (57.9%) followed the referral for hospital radiography. There were 102 cases (33.9%) that were diagnosed with scoliosis by radiography criteria (Cobb angle ≥10°) including mild scoliosis (Cobb 10-25) for 94 cases and moderate scoliosis (Cobb 25-40) for 8 cases, and false-positives (Cobb 0) for 39 cases. The putative prevalence rate was estimated as 1.9% from the referred students. Under an accurate and modern assessment system, school screenings can detect scoliosis at a significant rate, but awareness of scoliosis risks is needed for residents in China to take up referrals for hospital diagnosis after school screenings.

Methodological challenges in assessing the environmental status of a marine ecosystem: case study of the Baltic Sea.

PubMed

Ojaveer, Henn; Eero, Margit

2011-04-29

Assessments of the environmental status of marine ecosystems are increasingly needed to inform management decisions and regulate human pressures to meet the objectives of environmental policies. This paper addresses some generic methodological challenges and related uncertainties involved in marine ecosystem assessment, using the central Baltic Sea as a case study. The objectives of good environmental status of the Baltic Sea are largely focusing on biodiversity, eutrophication and hazardous substances. In this paper, we conduct comparative evaluations of the status of these three segments, by applying different methodological approaches. Our analyses indicate that the assessment results are sensitive to a selection of indicators for ecological quality objectives that are affected by a broad spectrum of human activities and natural processes (biodiversity), less so for objectives that are influenced by a relatively narrow array of drivers (eutrophications, hazardous substances). The choice of indicator aggregation rule appeared to be of essential importance for assessment results for all three segments, whereas the hierarchical structure of indicators had only a minor influence. Trend-based assessment was shown to be a useful supplement to reference-based evaluation, being independent of the problems related to defining reference values and indicator aggregation methodologies. Results of this study will help in setting priorities for future efforts to improve environmental assessments in the Baltic Sea and elsewhere, and to ensure the transparency of the assessment procedure.

A Psychobiographical Study of Intuition in a Writer's Life: Paulo Coelho Revisited

PubMed Central

Mayer, Claude-Hélène; Maree, David

2017-01-01

Intuition is defined as a form of knowledge which materialises as awareness of thoughts, feelings and physical sensations. It is a key to a deeper understanding and meaningfulness. Intuition, used as a psychological function, supports the transmission and integration of perceptions from unconscious and conscious realms. This study uses a psychobiographical single case study approach to explore intuition across the life span of Paulo Coelho. Methodologically, the study is based on a single case study, using the methodological frame of Dilthey's modern hermeneutics. The author, Paulo Coelho, was chosen as a subject of research, based on the content analysis of first- and third-person perspective documents. Findings show that Paulo Coelho, as one of the most famous and most read contemporary authors in the world, uses his intuitions as a deeper guidance in life, for decision-making and self-development. Intuitive decision-making is described throughout his life and by referring to selected creative works. PMID:28904596

Variants in ZFHX3 are associated with atrial fibrillation in individuals of European ancestry

PubMed Central

Benjamin, Emelia J.; Rice, Kenneth M.; Arking, Dan E.; Pfeufer, Arne; van Noord, Charlotte; Smith, Albert V.; Schnabel, Renate B.; Bis, Joshua C.; Boerwinkle, Eric; Sinner, Moritz F.; Dehghan, Abbas; Lubitz, Steven A.; D’Agostino, Ralph B.; Lumley, Thomas; Ehret, Georg B.; Heeringa, Jan; Aspelund, Thor; Newton-Cheh, Christopher; Larson, Martin G.; Marciante, Kristin D.; Soliman, Elsayed Z.; Rivadeneira, Fernando; Wang, Thomas J.; Eiriksdottir, Gudny; Levy, Daniel; Psaty, Bruce M.; Li, Man; Chamberlain, Alanna M.; Hofman, Albert; Vasan, Ramachandran S.; Harris, Tamara B.; Rotter, Jerome I.; Kao, W.H. Linda; Agarwal, Sunil K.; Ch. Stricker, Bruno H.; Wang, Ke; Launer, Lenore J.; Smith, Nicholas L.; Chakravarti, Aravinda; Uitterlinden, Andre G.; Wolf, Philip A; Sotoodehnia, Nona; Kottgen, Anna; van Duijn, Cornelia M.; Lunetta, Kathryn L.; Heckbert, Susan R.; Gudnason, Vilmundur; Alonso, Alvaro; Kaab, Stefan; Ellinor, Patrick T.; Witteman, Jacqueline C.

2009-01-01

We conducted meta-analyses of genome-wide association studies (GWAS) for atrial fibrillation (AF) in participants from five community-based cohorts. Meta-analyses of 896 prevalent (15,768 referents) and 2,517 incident (21,337 referents) AF cases identified a novel locus for AF (ZFHX3, rs2106261, risk ratio [RR]=1.19; P=2.3×10−7), an association that was replicated in the German AF Network (odds ratio=1.44; P=1.6×10−11). Combining the discovery and replication results, rs2106261 was significantly associated with AF (RR=1.25; P=1.8×10−15). PMID:19597492

Interaction between scene-based and array-based contextual cueing.

PubMed

Rosenbaum, Gail M; Jiang, Yuhong V

2013-07-01

Contextual cueing refers to the cueing of spatial attention by repeated spatial context. Previous studies have demonstrated distinctive properties of contextual cueing by background scenes and by an array of search items. Whereas scene-based contextual cueing reflects explicit learning of the scene-target association, array-based contextual cueing is supported primarily by implicit learning. In this study, we investigated the interaction between scene-based and array-based contextual cueing. Participants searched for a target that was predicted by both the background scene and the locations of distractor items. We tested three possible patterns of interaction: (1) The scene and the array could be learned independently, in which case cueing should be expressed even when only one cue was preserved; (2) the scene and array could be learned jointly, in which case cueing should occur only when both cues were preserved; (3) overshadowing might occur, in which case learning of the stronger cue should preclude learning of the weaker cue. In several experiments, we manipulated the nature of the contextual cues present during training and testing. We also tested explicit awareness of scenes, scene-target associations, and arrays. The results supported the overshadowing account: Specifically, scene-based contextual cueing precluded array-based contextual cueing when both were predictive of the location of a search target. We suggest that explicit, endogenous cues dominate over implicit cues in guiding spatial attention.

Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study).

PubMed

Mukhopadhyay, Sanjay; Feldman, Michael D; Abels, Esther; Ashfaq, Raheela; Beltaifa, Senda; Cacciabeve, Nicolas G; Cathro, Helen P; Cheng, Liang; Cooper, Kumarasen; Dickey, Glenn E; Gill, Ryan M; Heaton, Robert P; Kerstens, René; Lindberg, Guy M; Malhotra, Reenu K; Mandell, James W; Manlucu, Ellen D; Mills, Anne M; Mills, Stacey E; Moskaluk, Christopher A; Nelis, Mischa; Patil, Deepa T; Przybycin, Christopher G; Reynolds, Jordan P; Rubin, Brian P; Saboorian, Mohammad H; Salicru, Mauricio; Samols, Mark A; Sturgis, Charles D; Turner, Kevin O; Wick, Mark R; Yoon, Ji Y; Zhao, Po; Taylor, Clive R

2018-01-01

Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of ≥4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9% for WSI and 4.6% for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4% (95% confidence interval, -0.30% to 1.01%). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8%), neoplastic kidney pathology (1.5%), urinary bladder pathology (1.3%), and gynecologic pathology (1.2%). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a wide variety of organ systems and specimen types.

Limitations of the Mycobacterium tuberculosis reference genome H37Rv in the detection of virulence-related loci.

PubMed

O'Toole, Ronan F; Gautam, Sanjay S

2017-10-01

The genome sequence of Mycobacterium tuberculosis strain H37Rv is an important and valuable reference point in the study of M. tuberculosis phylogeny, molecular epidemiology, and drug-resistance mutations. However, it is becoming apparent that use of H37Rv as a sole reference genome in analysing clinical isolates presents some limitations to fully investigating M. tuberculosis virulence. Here, we examine the presence of single locus variants and the absence of entire genes in H37Rv with respect to strains that are responsible for cases and outbreaks of tuberculosis. We discuss how these polymorphisms may affect phenotypic properties of H37Rv including pathogenicity. Based on our observations and those of other researchers, we propose that use of a single reference genome, H37Rv, is not sufficient for the detection and characterisation of M. tuberculosis virulence-related loci. We recommend incorporation of genome sequences of other reference strains, in particular, direct clinical isolates, in such analyses in addition to H37Rv. Copyright © 2017 Elsevier Inc. All rights reserved.

46,XX males: a case series based on clinical and genetics evaluation.

PubMed

Mohammadpour Lashkari, F; Totonchi, M; Zamanian, M R; Mansouri, Z; Sadighi Gilani, M A; Sabbaghian, M; Mohseni Meybodi, A

2017-09-01

46,XX male sex reversal syndrome is one of the rarest sex chromosomal aberrations. The presence of SRY gene on one of the X chromosomes is the most frequent cause of this syndrome. Based on Y chromosome profile, there are SRY-positive and SRY-negative forms. The purpose of our study was to report first case series of Iranian patients and describe the different clinical appearances based on their genetic component. From the 8,114 azoospermic and severe oligozoospermic patients referred to Royan institute, we diagnosed 57 cases as sex reversal patients. Based on the endocrinological history, we performed karyotyping, SRY and AZF microdeletion screening. Patients had a female karyotype. According to available hormonal reports of 37 patients, 16 cases had low levels of testosterone (43.2%). On the other hand, 15 males were SRY positive (90.2%), while they lacked the spermatogenic factors encoding genes on Yq. Commencing the testicular differentiation in males, the SRY gene is considered to be very important in this process. Due to homogeneous results of karyotyping and AZF deletion, there are both positive and negative SRY cases that show similar sex reversal phenotypes. Evidences show that there could be diverse phenotypic differences that could be raised from various reasons. © 2016 Blackwell Verlag GmbH.

Quantifying the climate effects of bioenergy – Choice of reference system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koponen, Kati; Soimakallio, Sampo; Kline, Keith L.

In order to understand the climate effects of a bioenergy system, a comparison between the bioenergy system and a reference system is required. The reference system describes the situation that occurs in the absence of the bioenergy system with respect to the use of land, energy, and materials. The importance of reference systems is discussed in the literature but guidance on choosing suitable reference systems for assessing climate effects of bioenergy is limited. The reference system should align with the purpose of the study. Transparency of reference system assumptions is essential for proper interpretation of bioenergy assessments. This paper presentsmore » guidance for selecting suitable reference systems. Particular attention is given to choosing the land reference. If the goal is to study the climate effects of bioenergy as a part of total anthropogenic activity the reference system should illustrate what is expected in the absence of human activities. In such a case the suitable land reference is natural regeneration, and energy or material reference systems are not relevant. If the goal is to assess the effect of a change in bioenergy use, the reference system should incorporate human activities. In this case suitable reference systems describe the most likely alternative uses of the land, energy and materials in the absence of the change in bioenergy use. The definition of the reference system is furthermore subject to the temporal scope of the study. In practice, selecting and characterizing reference systems will involve various choices and uncertainties which should be considered carefully. As a result, it can be instructive to consider how alternative reference systems influence the results and conclusions drawn from bioenergy assessments.« less

Quantifying the climate effects of bioenergy – Choice of reference system

DOE PAGES

Koponen, Kati; Soimakallio, Sampo; Kline, Keith L.; ...

2017-06-27

In order to understand the climate effects of a bioenergy system, a comparison between the bioenergy system and a reference system is required. The reference system describes the situation that occurs in the absence of the bioenergy system with respect to the use of land, energy, and materials. The importance of reference systems is discussed in the literature but guidance on choosing suitable reference systems for assessing climate effects of bioenergy is limited. The reference system should align with the purpose of the study. Transparency of reference system assumptions is essential for proper interpretation of bioenergy assessments. This paper presentsmore » guidance for selecting suitable reference systems. Particular attention is given to choosing the land reference. If the goal is to study the climate effects of bioenergy as a part of total anthropogenic activity the reference system should illustrate what is expected in the absence of human activities. In such a case the suitable land reference is natural regeneration, and energy or material reference systems are not relevant. If the goal is to assess the effect of a change in bioenergy use, the reference system should incorporate human activities. In this case suitable reference systems describe the most likely alternative uses of the land, energy and materials in the absence of the change in bioenergy use. The definition of the reference system is furthermore subject to the temporal scope of the study. In practice, selecting and characterizing reference systems will involve various choices and uncertainties which should be considered carefully. As a result, it can be instructive to consider how alternative reference systems influence the results and conclusions drawn from bioenergy assessments.« less

Tisettanta case study: the interoperation of furniture production companies

NASA Astrophysics Data System (ADS)

Amarilli, Fabrizio; Spreafico, Alberto

This chapter presents the Tisettanta case study, focusing on the definition of the possible innovations that ICT technologies can bring to the Italian wood-furniture industry. This sector is characterized by industrial clusters composed mainly of a few large companies with international brand reputations and a large base of SMEs that manufacture finished products or are specialized in the production of single components/processes (such as the Brianza cluster, where Tisettanta operates). In this particular business ecosystem, ICT technologies can bring relevant support and improvements to the supply chain process, where collaborations between enterprises are put into action through the exchange of business documents such as orders, order confirmation, bills of lading, invoices, etc. The analysis methodology adopted in the Tisettanta case study refers to the TEKNE Methodology of Change (see Chapter 2), which defines a framework for supporting firms in the adoption of the Internetworked Enterprise organizational paradigm.

Occupational exposures and cancer of the colon and rectum.

PubMed

Gerhardsson de Verdier, M; Plato, N; Steineck, G; Peters, J M

1992-01-01

The associations between occupational risks and colorectal cancer were examined in a Swedish population-based, case-referent study. The study was performed in Stockholm in 1986-1988 and included 569 cases and 512 referents. Relative risks (RRs) with 95% confidence intervals were calculated for different occupations/chemicals. Elevated risks of colon cancer were found among male petrol station/automobile repair workers (RR = 2.3, 0.8-6.6) and among males exposed to asbestos (RR = 1.8, 0.9-3.6), while elevated risks of rectal cancer were found among males exposed to soot (RR = 2.2, 1.1-4.3), asbestos (RR = 2.2, 1.0-4.7), cutting fluids/oils (RR = 2.1, 1.1-4.0), and combustion gases from coal/coke/wood (RR = 1.9, 1.0-3.7). However, due to a high correlation between the above-mentioned variables and the few exposed subjects, it is difficult to separate their effects properly. These analyses were adjusted for age. Further adjustments for diet, body mass, and physical activity had little or no influence on the results.

Applications of surface metrology in firearm identification

NASA Astrophysics Data System (ADS)

Zheng, X.; Soons, J.; Vorburger, T. V.; Song, J.; Renegar, T.; Thompson, R.

2014-01-01

Surface metrology is commonly used to characterize functional engineering surfaces. The technologies developed offer opportunities to improve forensic toolmark identification. Toolmarks are created when a hard surface, the tool, comes into contact with a softer surface and causes plastic deformation. Toolmarks are commonly found on fired bullets and cartridge cases. Trained firearms examiners use these toolmarks to link an evidence bullet or cartridge case to a specific firearm, which can lead to a criminal conviction. Currently, identification is typically based on qualitative visual comparison by a trained examiner using a comparison microscope. In 2009, a report by the National Academies called this method into question. Amongst other issues, they questioned the objectivity of visual toolmark identification by firearms examiners. The National Academies recommended the development of objective toolmark identification criteria and confidence limits. The National Institute of Standards and Technology (NIST) have applied its experience in surface metrology to develop objective identification criteria, measurement methods, and reference artefacts for toolmark identification. NIST developed the Standard Reference Material SRM 2460 standard bullet and SRM 2461 standard cartridge case to facilitate quality control and traceability of identifications performed in crime laboratories. Objectivity is improved through measurement of surface topography and application of unambiguous surface similarity metrics, such as the maximum value (ACCFMAX) of the areal cross correlation function. Case studies were performed on consecutively manufactured tools, such as gun barrels and breech faces, to demonstrate that, even in this worst case scenario, all the tested tools imparted unique surface topographies that were identifiable. These studies provide scientific support for toolmark evidence admissibility in criminal court cases.

Cohort mortality study of North American industrial sand workers. III. Estimation of past and present exposures to respirable crystalline silica.

PubMed

Rando, R J; Shi, R; Hughes, J M; Weill, H; McDonald, A D; McDonald, J C

2001-04-01

Lung cancer and silicosis mortality were examined longitudinally and by a case-referent analysis in a cohort of workers selected from the North American industrial sand industry. Date of hire in the case-referent sub-cohort extended as far back as the second decade of the twentieth century. The aim of this study component was to develop estimates of average and cumulative exposure to respirable crystalline silica for the 342 selected cases and referents. Process and dust control histories were developed for each plant, and quantitative exposure data obtained from each of them and from a trade organization. An algorithm was developed to convert historical exposures reported in particle count concentrations to modern measures of mass concentration of respirable crystalline silica. Personal exposures were adjusted for use of protective equipment based on frequency of use and type of protection. Between 1974 and 1998, a total of 14249 exposure measurements had been taken using a cyclone and membrane filter and gave an overall geometric mean of 42 microg/m3. The only exposure data identified earlier were based on approximately 500 samples collected across the industry between 1947 and 1955 using the Greenburg-Smith impinger, with analysis by microscopy. These data were converted to modern measures using a factor of 1 mppcf = 276 microg/m3 respirable dust and then adjusting for percentage silica. In general, the highest exposures occurred in bagging and bulk-loading operations and the lowest in wet processing of sand. There has been a substantial decline in exposure levels in this industry over time. The decline was rapid between the 1940s and 1970s and current exposures are, on average, less than 50 microg/m3. The use of personal protective equipment was judged to have had little impact on exposure before the 1970s.

A value-based medicine analysis of ranibizumab for the treatment of subfoveal neovascular macular degeneration.

PubMed

Brown, Melissa M; Brown, Gary C; Brown, Heidi C; Peet, Jonathan

2008-06-01

To assess the conferred value and average cost-utility (cost-effectiveness) for intravitreal ranibizumab used to treat occult/minimally classic subfoveal choroidal neovascularization associated with age-related macular degeneration (AMD). Value-based medicine cost-utility analysis. MARINA (Minimally Classic/Occult Trial of the Anti-Vascular Endothelial Growth Factor Antibody Ranibizumab in the Treatment of Neovascular AMD) Study patients utilizing published primary data. Reference case, third-party insurer perspective, cost-utility analysis using 2006 United States dollars. Conferred value in the forms of (1) quality-adjusted life-years (QALYs) and (2) percent improvement in health-related quality of life. Cost-utility is expressed in terms of dollars expended per QALY gained. All outcomes are discounted at a 3% annual rate, as recommended by the Panel on Cost-effectiveness in Health and Medicine. Data are presented for the second-eye model, first-eye model, and combined model. Twenty-two intravitreal injections of 0.5 mg of ranibizumab administered over a 2-year period confer 1.039 QALYs, or a 15.8% improvement in quality of life for the 12-year period of the second-eye model reference case of occult/minimally classic age-related subfoveal choroidal neovascularization. The reference case treatment cost is $52652, and the cost-utility for the second-eye model is $50691/QALY. The quality-of-life gain from the first-eye model is 6.4% and the cost-utility is $123887, whereas the most clinically simulating combined model yields a quality-of-life gain of 10.4% and cost-utility of $74169. By conventional standards and the most commonly used second-eye and combined models, intravitreal ranibizumab administered for occult/minimally classic subfoveal choroidal neovascularization is a cost-effective therapy. Ranibizumab treatment confers considerably greater value than other neovascular macular degeneration pharmaceutical therapies that have been studied in randomized clinical trials.

Palliative care case managers in primary care: a descriptive study of referrals in relation to treatment aims.

PubMed

van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Francke, Anneke L; Jansen, Wim J J; Vissers, Kris C; Deliens, Luc

2015-04-01

Three important elements of the World Health Organization (WHO) definition of palliative care are: 1) it includes patients who may have cure or life prolongation as treatment aims besides palliative care; 2) it is not exclusively for cancer patients; and 3) it includes attention to the medical, psychological, social, and spiritual needs of the patients and their families. Case managers (nurses with expertise in palliative care) may assist generalist primary care providers in delivery of good palliative care. This study investigates the referral of patients to case managers in primary care with regard to the three elements mentioned: diagnosis, treatment aims, and needs as reflected in reasons given for referral. In this cross-sectional survey in primary care among case managers and referrers to case management, case managers completed questionnaires for 687 patients; referrers completed 448 (65%). Most patients referred have a combination of treatment aims (69%). Life expectancy and functional status of patients are lower for those with a treatment aim of palliation. Almost all (96%) of those referred are cancer patients. A need for psychosocial support is frequently given as a reason for referral (66%) regardless of treatment aim. Referrals to case managers reflect two of three elements of the WHO definition. Mainly, patients are referred for support complementary to medical care, and relatively early in their disease trajectory. However, most of those referred are cancer patients. Thus, to fully reflect the definition, broadening the scope to reach other patient groups is important.

The case-control design in veterinary sciences: A survey.

PubMed

Cullen, Jonah N; Sargeant, Jan M; Makielski, Kelly M; O'Connor, Annette M

2016-11-01

The case-control study design is deceptively simple. However, many design considerations influence the estimated effect measure. An investigation of case-control studies in the human health literature suggested that some of these considerations are not described in reports of case-control studies. Our hypothesis was that the majority of veterinary studies labeled as case-controls would be incident density designs, and many would not interpret the effect measure obtained from those studies as the rate ratio rather than the odds ratio. Reference databases were searched for author-designated case-control studies. A survey of 100 randomly selected studies was conducted to examine the different design options described and estimated effect measures. Of the 100 author-identified case-control studies, 83 assessed an exposure-outcome association and, of those, only 54 (65.1%) sampled the study population based on an outcome and would thus be considered case-control designs. Twelve studies were incidence density designs but none used this terminology. Of the studies that reported an odds ratio as the effect measure, none reported on additional considerations that would have enabled a more interpretable result. This survey indicated many case-control-labeled studies were not case-control designs and among case-control studies, key design aspects were not often described. The absence of information about study design elements and underlying assumptions in case-control studies limits the ability to establish the effect measured by the study and the evidentiary value of the study might be underestimated. Copyright © 2016 Elsevier B.V. All rights reserved.

Evaluation of continuing education of family health strategy teams for the early identification of suspected cases of cancer in children.

PubMed

Costa, Ana Maria Aranha Magalhaes; Magluta, Cynthia; Gomes Junior, Saint Clair

2017-09-07

This study evaluated the influence of continuing education of family health strategy teams by the Ronald McDonald Institute program on the early diagnosis of cancer in children and adolescents. The study applied Habicht's model to evaluate the adequacy and plausibility of continuing education by using as outcome the number of children with suspected cancer who were referred to the hospital of references in the 1 year before and 1 year after intervention and the number of patients referred by intervention group and control group family health strategy teams. Medical records from each hospital of reference were used to collect information of suspect cases of cancer. Descriptive analyses were performed using frequencies and mean values. Chi-square tests were used to assess statistically significant differences between the groups and periods by using p-values < 0.05. The results showed a 30.6% increase in the number of children referred to the hospital of reference for suspected cancer in the post-intervention period; in addition, the family health strategy teams that underwent the intervention referred 3.6 times more number of children to hospital of references than did the control group. Only the intervention group showed an increase in the number of confirmed cases. This evaluation of a continuing education program for early identification of pediatric cancer showed that the program was adequate in achieving the established goals and that the results could be attributed to the program.

Vertical separation of the atmospheric aerosol components by using poliphon retrieval in polarized micro pulse lidar (P-MPL) measurements: case studies of specific climate-relevant aerosol types

NASA Astrophysics Data System (ADS)

Córdoba-Jabonero, Carmen; Sicard, Michaël; Ansmann, Albert; Águila, Ana del; Baars, Holger

2018-04-01

POLIPHON (POlarization-LIdar PHOtometer Networking) retrieval consists in the vertical separation of two/three particle components in aerosol mixtures, highlighting their relative contributions in terms of the optical properties and mass concentrations. This method is based on the specific particle linear depolarization ratio given for different types of aerosols, and is applied to the new polarized Micro-Pulse Lidar (P-MPL). Case studies of specific climate-relevant aerosols (dust particles, fire smoke, and pollen aerosols, including a clean case as reference) observed over Barcelona (Spain) are presented in order to evaluate firstly the potential of P-MPLs measurements in combination with POLIPHON for retrieving the vertical separation of those particle components forming aerosol mixtures and their properties.

Report on New Methods for Representing and Interacting with Qualitative Geographic Information, Stage 2: Task Group 1 Core Re-engineering and Place-based Use Case

DTIC Science & Technology

2013-06-30

Void, Behind you, Quantum Leaping, The space between spaces  when a geographic reference is provided, we identified several categories of challenges to... consciously opt-in to include geolocation in times of crisis. In addition, 10% of tweets in our sample included place references in the text and that

A validated case definition for chronic rhinosinusitis in administrative data: a Canadian perspective.

PubMed

Rudmik, Luke; Xu, Yuan; Kukec, Edward; Liu, Mingfu; Dean, Stafford; Quan, Hude

2016-11-01

Pharmacoepidemiological research using administrative databases has become increasingly popular for chronic rhinosinusitis (CRS); however, without a validated case definition the cohort evaluated may be inaccurate resulting in biased and incorrect outcomes. The objective of this study was to develop and validate a generalizable administrative database case definition for CRS using International Classification of Diseases, 9th edition (ICD-9)-coded claims. A random sample of 100 patients with a guideline-based diagnosis of CRS and 100 control patients were selected and then linked to a Canadian physician claims database from March 31, 2010, to March 31, 2015. The proportion of CRS ICD-9-coded claims (473.x and 471.x) for each of these 200 patients were reviewed and the validity of 7 different ICD-9-based coding algorithms was evaluated. The CRS case definition of ≥2 claims with a CRS ICD-9 code (471.x or 473.x) within 2 years of the reference case provides a balanced validity with a sensitivity of 77% and specificity of 79%. Applying this CRS case definition to the claims database produced a CRS cohort of 51,000 patients with characteristics that were consistent with published demographics and rates of comorbid asthma, allergic rhinitis, and depression. This study has validated several coding algorithms; based on the results a case definition of ≥2 physician claims of CRS (ICD-9 of 471.x or 473.x) within 2 years provides an optimal level of validity. Future studies will need to validate this administrative case definition from different health system perspectives and using larger retrospective chart reviews from multiple providers. © 2016 ARS-AAOA, LLC.

Pneumafil casing blower through moving reference frame (MRF) - A CFD simulation

NASA Astrophysics Data System (ADS)

Manivel, R.; Vijayanandh, R.; Babin, T.; Sriram, G.

2018-05-01

In this analysis work, the ring frame of Pneumafil casing blower of the textile mills with a power rating of 5 kW have been simulated using Computational Fluid Dynamics (CFD) code. The CFD analysis of the blower is carried out in Ansys Workbench 16.2 with Fluent using MRF solver settings. The simulation settings and boundary conditions are based on literature study and field data acquired. The main objective of this work is to reduce the energy consumption of the blower. The flow analysis indicated that the power consumption is influenced by the deflector plate orientation and deflector plate strip situated at the outlet casing of the blower. The energy losses occurred in the blower is due to the recirculation zones formed around the deflector plate strip. The deflector plate orientation is changed and optimized to reduce the energy consumption. The proposed optimized model is based on the simulation results which had relatively lesser power consumption than the existing and other cases. The energy losses in the Pneumafil casing blower are reduced through CFD analysis.

Model-Free Primitive-Based Iterative Learning Control Approach to Trajectory Tracking of MIMO Systems With Experimental Validation.

PubMed

Radac, Mircea-Bogdan; Precup, Radu-Emil; Petriu, Emil M

2015-11-01

This paper proposes a novel model-free trajectory tracking of multiple-input multiple-output (MIMO) systems by the combination of iterative learning control (ILC) and primitives. The optimal trajectory tracking solution is obtained in terms of previously learned solutions to simple tasks called primitives. The library of primitives that are stored in memory consists of pairs of reference input/controlled output signals. The reference input primitives are optimized in a model-free ILC framework without using knowledge of the controlled process. The guaranteed convergence of the learning scheme is built upon a model-free virtual reference feedback tuning design of the feedback decoupling controller. Each new complex trajectory to be tracked is decomposed into the output primitives regarded as basis functions. The optimal reference input for the control system to track the desired trajectory is next recomposed from the reference input primitives. This is advantageous because the optimal reference input is computed straightforward without the need to learn from repeated executions of the tracking task. In addition, the optimization problem specific to trajectory tracking of square MIMO systems is decomposed in a set of optimization problems assigned to each separate single-input single-output control channel that ensures a convenient model-free decoupling. The new model-free primitive-based ILC approach is capable of planning, reasoning, and learning. A case study dealing with the model-free control tuning for a nonlinear aerodynamic system is included to validate the new approach. The experimental results are given.

New alternatives for reference evapotranspiration estimation in West Africa using limited weather data and ancillary data supply strategies.

NASA Astrophysics Data System (ADS)

Landeras, Gorka; Bekoe, Emmanuel; Ampofo, Joseph; Logah, Frederick; Diop, Mbaye; Cisse, Madiama; Shiri, Jalal

2018-05-01

Accurate estimation of reference evapotranspiration ( ET 0 ) is essential for the computation of crop water requirements, irrigation scheduling, and water resources management. In this context, having a battery of alternative local calibrated ET 0 estimation methods is of great interest for any irrigation advisory service. The development of irrigation advisory services will be a major breakthrough for West African agriculture. In the case of many West African countries, the high number of meteorological inputs required by the Penman-Monteith equation has been indicated as constraining. The present paper investigates for the first time in Ghana, the estimation ability of artificial intelligence-based models (Artificial Neural Networks (ANNs) and Gene Expression Programing (GEPs)), and ancillary/external approaches for modeling reference evapotranspiration ( ET 0 ) using limited weather data. According to the results of this study, GEPs have emerged as a very interesting alternative for ET 0 estimation at all the locations of Ghana which have been evaluated in this study under different scenarios of meteorological data availability. The adoption of ancillary/external approaches has been also successful, moreover in the southern locations. The interesting results obtained in this study using GEPs and some ancillary approaches could be a reference for future studies about ET 0 estimation in West Africa.

The NASA/MSFC global reference atmospheric model: 1990 version (GRAM-90). Part 2: Program/data listings

NASA Technical Reports Server (NTRS)

Justus, C. G.; Alyea, F. N.; Cunnold, D. M.; Jeffries, W. R., III; Johnson, D. L.

1991-01-01

A new (1990) version of the NASA/MSFC Global Reference Atmospheric Model (GRAM-90) was completed and the program and key data base listing are presented. GRAM-90 incorporate extensive new data, mostly collected under the Middle Atmosphere Program, to produce a completely revised middle atmosphere model (20 to 120 km). At altitudes greater than 120 km, GRAM-90 uses the NASA Marshall Engineering Thermosphere model. Complete listings of all program and major data bases are presented. Also, a test case is included.

DORMAN computer program (study 2.5). Volume 3: Original data bank listing. [development of data bank for computerized information storage of NASA programs

NASA Technical Reports Server (NTRS)

Stricker, L. T.

1973-01-01

A number of analyses have been performed using the DORCA program for several NASA-funded Aerospace Corporation studies in the past few years. The data decks containing the input data for these analyses have been compiled and are submitted, under separate cover. A few of the data decks are full (basic) decks containing every data item and are used as reference decks in the data bank. The other data decks were obtained by differencing a full deck with respect to one of the reference decks. Using the DORMAN program, a full deck can be recreated from the modified deck and its reference deck when and if desired. The content and structure of the data bank are described. A description of each of these data decks is presented. Three of the cases that are included in this volume have become so widely recognized and accepted that additional descriptive material has been provided. The three cases are: Case 500 Costs, Case 506 Costs, and Case 403.

Navigation analysis for Viking 1979, option B

NASA Technical Reports Server (NTRS)

Mitchell, P. H.

1971-01-01

A parametric study performed for 48 trans-Mars reference missions in support of the Viking program is reported. The launch dates cover several months in the year 1979, and each launch date has multiple arrival dates in 1980. A plot of launch versus arrival dates with case numbers designated for reference purposes is included. The analysis consists of the computation of statistical covariance matrices based on certain assumptions about the ground-based tracking systems. The error model statistics are listed in tables. Tracking systems were assumed at three sites: Goldstone, California; Canberra, Australia; and Madrid, Spain. The tracking data consisted of range and Doppler measurements taken during the tracking intervals starting at E-30(d) and ending at E-10(d) for the control data and ending at E-18(h) for the knowledge data. The control and knowledge covariance matrices were delivered to the Planetary Mission Analysis Branch for inputs into a delta V dispersion analysis.

Characterization of aluminum nitride based films with high resolution X-ray fluorescence spectroscopy

NASA Astrophysics Data System (ADS)

Anagnostopoulos, D. F.; Siozios, A.; Patsalas, P.

2018-02-01

X-ray fluorescence spectra of Al based films are measured, using a lab-scale wavelength dispersive flat crystal spectrometer. Various structures of AlN films were studied, like single layered, capped, stratified, nanostructured, crystalline, or amorphous. By optimizing the set-up for enhanced energy resolution and detection efficiency, the measured line shapes of Κα, Kβ, and KLL radiative Auger transitions are shown to be adequately detailed to allow chemical characterization. The chemistry identification is based on the pattern comparison of the emitted line shape from the chemically unknown film and the reference line shapes from standard materials, recorded under identical experimental conditions. The ultimate strength of lab-scale high resolution X-ray fluorescence spectroscopy on film analysis is verified, in cases that ordinary applied techniques like X-ray photoelectron and X-ray diffraction fail, while the characterization refers to the non-destructive determination of the bulk properties of the film and not to its surface, as the probed depth is in the micrometer range.

Medical applications of model-based dynamic thermography

NASA Astrophysics Data System (ADS)

Nowakowski, Antoni; Kaczmarek, Mariusz; Ruminski, Jacek; Hryciuk, Marcin; Renkielska, Alicja; Grudzinski, Jacek; Siebert, Janusz; Jagielak, Dariusz; Rogowski, Jan; Roszak, Krzysztof; Stojek, Wojciech

2001-03-01

The proposal to use active thermography in medical diagnostics is promising in some applications concerning investigation of directly accessible parts of the human body. The combination of dynamic thermograms with thermal models of investigated structures gives attractive possibility to make internal structure reconstruction basing on different thermal properties of biological tissues. Measurements of temperature distribution synchronized with external light excitation allow registration of dynamic changes of local temperature dependent on heat exchange conditions. Preliminary results of active thermography applications in medicine are discussed. For skin and under- skin tissues an equivalent thermal model may be determined. For the assumed model its effective parameters may be reconstructed basing on the results of transient thermal processes. For known thermal diffusivity and conductivity of specific tissues the local thickness of a two or three layer structure may be calculated. Results of some medical cases as well as reference data of in vivo study on animals are presented. The method was also applied to evaluate the state of the human heart during the open chest cardio-surgical interventions. Reference studies of evoked heart infarct in pigs are referred, too. We see the proposed new in medical applications technique as a promising diagnostic tool. It is a fully non-invasive, clean, handy, fast and affordable method giving not only qualitative view of investigated surfaces but also an objective quantitative measurement result, accurate enough for many applications including fast screening of affected tissues.

An all-solid-state reference electrode based on the layer-by-layer polymer coating.

PubMed

Kwon, Nak-Hyun; Lee, Kyung-Sun; Won, Mi-Sook; Shim, Yoon-Bo

2007-09-01

A solid-state reference electrode (SSRE) was fabricated by layering a silicone rubber (SR) film containing KCl on an AgCl surface, then a perfluorinated ionomer film, and finally a polyurethane-based membrane containing an ionophore, a lipophilic ionic additive, and a plasticizer, respectively. The addition of SiCl4 to the polyurethane-based membrane layer enhanced the strength of the membrane in an aqueous solution. The morphologies of the membranes were studied separately by SEM. The fabrication of the Ag/AgCl electrode through this layer-by-layer polymer coating improved the electrode stability enormously. In addition, the potential drift of the SSRE according to the pH of the medium was minimized by introducing a H+-ion-selective ionophore (tridodecylamine; TDDA) into the outmost polymer membrane. The cyclic voltammetric and potentiometric responses using the SSRE and a conventional reference electrode, respectively, were consistent. The SSRE exhibited little potential variation even in the case of the addition of very high concentrations of various salts, such as Na salicylate, LiCl, KCl, CaCl2, MgCl2, KNO3, NaCl, and NaHCO3. The practicability of the proposed SSRE was tested for the determination of blood pH and pCO2 in a flow cell system. The SSRE fabricated in the present study was stable over two years.

Deviation from equilibrium conditions in molecular dynamic simulations of homogeneous nucleation.

PubMed

Halonen, Roope; Zapadinsky, Evgeni; Vehkamäki, Hanna

2018-04-28

We present a comparison between Monte Carlo (MC) results for homogeneous vapour-liquid nucleation of Lennard-Jones clusters and previously published values from molecular dynamics (MD) simulations. Both the MC and MD methods sample real cluster configuration distributions. In the MD simulations, the extent of the temperature fluctuation is usually controlled with an artificial thermostat rather than with more realistic carrier gas. In this study, not only a primarily velocity scaling thermostat is considered, but also Nosé-Hoover, Berendsen, and stochastic Langevin thermostat methods are covered. The nucleation rates based on a kinetic scheme and the canonical MC calculation serve as a point of reference since they by definition describe an equilibrated system. The studied temperature range is from T = 0.3 to 0.65 ϵ/k. The kinetic scheme reproduces well the isothermal nucleation rates obtained by Wedekind et al. [J. Chem. Phys. 127, 064501 (2007)] using MD simulations with carrier gas. The nucleation rates obtained by artificially thermostatted MD simulations are consistently lower than the reference nucleation rates based on MC calculations. The discrepancy increases up to several orders of magnitude when the density of the nucleating vapour decreases. At low temperatures, the difference to the MC-based reference nucleation rates in some cases exceeds the maximal nonisothermal effect predicted by classical theory of Feder et al. [Adv. Phys. 15, 111 (1966)].

Deviation from equilibrium conditions in molecular dynamic simulations of homogeneous nucleation

NASA Astrophysics Data System (ADS)

Halonen, Roope; Zapadinsky, Evgeni; Vehkamäki, Hanna

2018-04-01

We present a comparison between Monte Carlo (MC) results for homogeneous vapour-liquid nucleation of Lennard-Jones clusters and previously published values from molecular dynamics (MD) simulations. Both the MC and MD methods sample real cluster configuration distributions. In the MD simulations, the extent of the temperature fluctuation is usually controlled with an artificial thermostat rather than with more realistic carrier gas. In this study, not only a primarily velocity scaling thermostat is considered, but also Nosé-Hoover, Berendsen, and stochastic Langevin thermostat methods are covered. The nucleation rates based on a kinetic scheme and the canonical MC calculation serve as a point of reference since they by definition describe an equilibrated system. The studied temperature range is from T = 0.3 to 0.65 ɛ/k. The kinetic scheme reproduces well the isothermal nucleation rates obtained by Wedekind et al. [J. Chem. Phys. 127, 064501 (2007)] using MD simulations with carrier gas. The nucleation rates obtained by artificially thermostatted MD simulations are consistently lower than the reference nucleation rates based on MC calculations. The discrepancy increases up to several orders of magnitude when the density of the nucleating vapour decreases. At low temperatures, the difference to the MC-based reference nucleation rates in some cases exceeds the maximal nonisothermal effect predicted by classical theory of Feder et al. [Adv. Phys. 15, 111 (1966)].

A CASE STUDY OF THE REFERENCE CONDITION APPROACH TO NITROGEN MANAGEMENT IN ESTUARIES

EPA Science Inventory

One way to estimate estuarine response to changes in nitrogen loading in coastal systems is by using a reference approach. This talk details the application of paleoecological analysis and use of historical data to estimate reference loads of nitrogen to New Bedford Harbor (NBH),...

Measures of Bulk and Grain Strain in Deformation Processes(PREPRINT)

DTIC Science & Technology

2007-04-01

the process and a similar measure of the flow stress of the material. The effective , or equivalent, strain, based on an analogous definition for...The conjugate effective stress in this case is the uniaxial tensile stress . Based on equations (12) and (13), expressions for effective bulk strains...t |L(t)| in the reference state deformed to an image, x′ = t′ | L′(t′)|, in the deformed state . In both cases an equation of the form of

Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda.

PubMed

Nanyonjo, Agnes; Bagorogoza, Benson; Kasteng, Frida; Ayebale, Godfrey; Makumbi, Fredrick; Tomson, Göran; Källander, Karin

2015-08-28

Integrated community case management (iCCM) relies on community health workers (CHWs) managing children with malaria, pneumonia, diarrhoea, and referring children when management is not possible. This study sought to establish the cost per sick child referred to seek care from a higher-level health facility by a CHW and to estimate caregivers' willingness to pay (WTP) for referral. Caregivers of 203 randomly selected children referred to higher-level health facilities by CHWs were interviewed in four Midwestern Uganda districts. Questionnaires and document reviews were used to capture direct, indirect and opportunity costs incurred by caregivers, CHWs and health facilities managing referred children. WTP for referral was assessed through the 'bidding game' approach followed by an open-ended question on maximum WTP. Descriptive analysis was conducted for factors associated with referral completion and WTP using logistic and linear regression methods, respectively. The cost per case referred to higher-level health facilities was computed from a societal perspective. Reasons for referral included having fever with a negative malaria test (46.8%), danger signs (29.6%) and drug shortage (37.4%). Among the referred, less than half completed referral (45.8%). Referral completion was 2.8 times higher among children with danger signs (p = 0.004) relative to those without danger signs, and 0.27 times lower among children who received pre-referral treatment (p < 0.001). The average cost per case referred was US$ 4.89 and US$7.35 per case completing referral. For each unit cost per case referred, caregiver out of pocket expenditure contributed 33.7%, caregivers' and CHWs' opportunity costs contributed 29.2% and 5.1% respectively and health facility costs contributed 39.6%. The mean (SD) out of pocket expenditure was US$1.65 (3.25). The mean WTP for referral was US$8.25 (14.70) and was positively associated with having received pre-referral treatment, completing referral and increasing caregiver education level. The mean WTP for referral was higher than the average out of pocket expenditure. This, along with suboptimal referral completion, points to barriers in access to higher-level facilities as the primary cause of low referral. Community mobilisation for uptake of referral is necessary if the policy of referring children to the nearest health facility is to be effective.

[Reference ranges of gestational weight gain in Chinese population on the incidence of macrosomia: a multi-center cross-sectional survey].

PubMed

Liang, H; Zhang, W Y; Li, X T

2017-03-25

Objective: To investigate the influence of gestational weight gain (GWG) on the incidence of macrosomia, and to establish the reference ranges of GWG based on the incidence of macrosomia. Methods: A multicenter, cross-sectional study was conducted. Totally, 112 485 women were recruited from 39 hospitals in 14 provinces in China. Totally, 61 149 cases were eligible with singleton pregnancies and non-premature deliveries. The associations of pre-pregnancy body mass index (BMI), GWG, newborn gender and gestational diabetes with macrosomia were analyzed with logistic regression. The normal GWG ranges were calculated in all maternal BMI subgroups, based on the normal incidence of macrosomia was set as the range of 5.0% to 10.0%. Results: In this study, the incidence of macrosomia was 7.46% (4 563/611 149). The macrosociam was positive related with maternal height, delivery week, pre-pregnancy BMI, GWG, gestational diabetes, primipara, and male babies significantly ( P< 0.05), based on unadjusted and adjusted logestic regression. The normal range of GWG 20.0-25.0, 10.0-20.0, 0-10.0 and 0-5.0 kg in subgroups of underweight (pre-pregnancy BMI<18.5 kg/m(2)), normal (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)) and obese (≥30.0 kg/m(2)), respectively. Conclusion: The reference range of GWG in China based on the incidence of macrosomia is established.

In vivo verification of proton beam path by using post-treatment PET/CT imaging.

PubMed

Hsi, Wen C; Indelicato, Daniel J; Vargas, Carlos; Duvvuri, Srividya; Li, Zuofeng; Palta, Jatinder

2009-09-01

The purpose of this study is to establish the in vivo verification of proton beam path by using proton-activated positron emission distributions. A total of 50 PET/CT imaging studies were performed on ten prostate cancer patients immediately after daily proton therapy treatment through a single lateral portal. The PET/CT and planning CT were registered by matching the pelvic bones, and the beam path of delivered protons was defined in vivo by the positron emission distribution seen only within the pelvic bones, referred to as the PET-defined beam path. Because of the patient position correction at each fraction, the marker-defined beam path, determined by the centroid of implanted markers seen in the posttreatment (post-Tx) CT, is used for the planned beam path. The angular variation and discordance between the PET- and marker-defined paths were derived to investigate the intrafraction prostate motion. For studies with large discordance, the relative location between the centroid and pelvic bones seen in the post-Tx CT was examined. The PET/CT studies are categorized for distinguishing the prostate motion that occurred before or after beam delivery. The post-PET CT was acquired after PET imaging to investigate prostate motion due to physiological changes during the extended PET acquisition. The less than 2 degrees of angular variation indicates that the patient roll was minimal within the immobilization device. Thirty of the 50 studies with small discordance, referred as good cases, show a consistent alignment between the field edges and the positron emission distributions from the entrance to the distal edge. For those good cases, average displacements are 0.6 and 1.3 mm along the anterior-posterior (D(AP)) and superior-inferior (D(SI)) directions, respectively, with 1.6 mm standard deviations in both directions. For the remaining 20 studies demonstrating a large discordance (more than 6 mm in either D(AP) or D(SI)), 13 studies, referred as motion-after-Tx cases, also show large misalignment between the field edge and the positron emission distribution in lipomatous tissues around the prostate. These motion-after-Tx cases correspond to patients with large changes in volume of rectal gas between the post-Tx and the post-PET CTs. The standard deviations for D(AP) and D(SI) are 5.0 and 3.0 mm, respectively, for these motion-after-Tx cases. The final seven studies, referred to as position-error cases, which had a large discordance but no misalignment, were found to have deviations of 4.6 and 3.6 mm in D(AP) and D(SI), respectively. The position-error cases correspond to a large discrepancy on the relative location between the centroid and pelvic bones seen in post-Tx CT and recorded x-ray radiographs. Systematic analyses of proton-activated positron emission distributions provide patient-specific information on prostate motion (sigmaM) and patient position variability (sigmap) during daily proton beam delivery. The less than 2 mm of displacement variations in the good cases indicates that population-based values of sigmap and sigmaM, used in margin algorithms for treatment planning at the authors' institution are valid for the majority of cases. However, a small fraction of PET/CT studies (approximately 14%) with -4 mm displacement variations may require different margins. Such data are useful in establishing patient-specific planning target volume margins.

Revisiting the Logan plot to account for non-negligible blood volume in brain tissue.

PubMed

Schain, Martin; Fazio, Patrik; Mrzljak, Ladislav; Amini, Nahid; Al-Tawil, Nabil; Fitzer-Attas, Cheryl; Bronzova, Juliana; Landwehrmeyer, Bernhard; Sampaio, Christina; Halldin, Christer; Varrone, Andrea

2017-08-18

Reference tissue-based quantification of brain PET data does not typically include correction for signal originating from blood vessels, which is known to result in biased outcome measures. The bias extent depends on the amount of radioactivity in the blood vessels. In this study, we seek to revisit the well-established Logan plot and derive alternative formulations that provide estimation of distribution volume ratios (DVRs) that are corrected for the signal originating from the vasculature. New expressions for the Logan plot based on arterial input function and reference tissue were derived, which included explicit terms for whole blood radioactivity. The new methods were evaluated using PET data acquired using [ 11 C]raclopride and [ 18 F]MNI-659. The two-tissue compartment model (2TCM), with which signal originating from blood can be explicitly modeled, was used as a gold standard. DVR values obtained for [ 11 C]raclopride using the either blood-based or reference tissue-based Logan plot were systematically underestimated compared to 2TCM, and for [ 18 F]MNI-659, a proportionality bias was observed, i.e., the bias varied across regions. The biases disappeared when optimal blood-signal correction was used for respective tracer, although for the case of [ 18 F]MNI-659 a small but systematic overestimation of DVR was still observed. The new method appears to remove the bias introduced due to absence of correction for blood volume in regular graphical analysis and can be considered in clinical studies. Further studies are however required to derive a generic mapping between plasma and whole-blood radioactivity levels.

[Cases of menstrual toxic shock syndrome in the Czech Republic in 1997-2011].

PubMed

Petrás, P; Machová, I; Rysková, L; Prásil, P

2011-11-01

To determine toxigenicity and other basic characteristics of 47 strains of Staphylococcus aureus referred to the National Reference Laboratory for Staphylococci (NRL) as suspected causative agents of menstrual toxic shock syndrome (MTSS). S. aureus strains were collected from 11 administrative regions of the Czech Republic in 1997-2011. The diagnosis was based on phenotypic (reverse latex agglutination test) and genotypic (polymerase chain reaction) methods. Forty-four S. aureus strains were producers of toxic shock syndrome toxin 1 (TSST-1), either alone or in combination with staphylococcal enterotoxin. Three strains only produced enterotoxin (B, C, and H). MTSS is a serious multisystem disease. In this study, MTSS often had a severe course requiring intensive care. All MTSS patients used vaginal tampons that had been identified in the literature as a risk factor for MTSS. The case of MTSS in a 36-year-old woman caused by an enterotoxin H positive strain of S. aureus is probably the first to be reported in the world.

Innovations in human genetics education. Incorporation of genetics into a problem-based medical school curriculum.

PubMed Central

Swinford, A E; McKeag, D B

1990-01-01

There has been recent interest in the development of problem-based human genetics curricula in U.S. medical schools. The College of Human Medicine at Michigan State University has had a problem-based curriculum since 1974. The vertical integration of genetics within the problem-based curriculum, called "Track II," has recently been revised. On first inspection, the curriculum appeared to lack a significant genetics component; however, on further analysis it was found that many genetics concepts were covered in the biochemistry, microbiology, pathology, and clinical science components. Both basic science concepts and clinical applications of genetics are covered in the curriculum by providing appropriate references for basic concepts and including inherited conditions within the differential diagnosis in the cases studied. Evaluations consist of a multiple-choice content exam and a modified essay exam based on a clinical case, allowing evaluation of both basic concepts and problem-solving ability. This curriculum prepares students to use genetics in a clinical context in their future careers. PMID:2220816

Biowaiver extension potential and IVIVC for BCS Class II drugs by formulation design: Case study for cyclosporine self-microemulsifying formulation.

PubMed

Yang, Su-Geun

2010-11-01

The objective of this work was to suggest the biowaiver potential of biopharmaceutical classification system (BCS) Class II drugs in self-microemulsifying drug delivery systems (SMEDDS) which are known to increase the solubility, dissolution and oral absorption of water-insoluble drugs. Cyclosporine was selected as a representative BCS Class II drug. New generic candidate of cyclosporine SMEDDS (test) was applied for the study with brand SMEDDS (reference I) and cyclosporine self-emulsifying drug delivery systems (SEDDS, reference II). Solubility and dissolution of cyclosporine from SMEDDS were critically enhanced, which were the similar behaviors with BCS class I drug. The test showed the identical dissolution rate and the equivalent bioavailability (0.34, 0.42 and 0.68 of p values for AUC₀(→)₂₄(h), C(max) and T(max), respectively) with the reference I. Based on the results, level A in vitro-in vivo correlation (IVIVC) was established from these two SMEDDS formulations. This study serves as a good example for speculating the biowaiver extension potential of BCS Class II drugs specifically in solubilizing formulation such as SMEDDS.

An approach to checking case-crossover analyses based on equivalence with time-series methods.

PubMed

Lu, Yun; Symons, James Morel; Geyh, Alison S; Zeger, Scott L

2008-03-01

The case-crossover design has been increasingly applied to epidemiologic investigations of acute adverse health effects associated with ambient air pollution. The correspondence of the design to that of matched case-control studies makes it inferentially appealing for epidemiologic studies. Case-crossover analyses generally use conditional logistic regression modeling. This technique is equivalent to time-series log-linear regression models when there is a common exposure across individuals, as in air pollution studies. Previous methods for obtaining unbiased estimates for case-crossover analyses have assumed that time-varying risk factors are constant within reference windows. In this paper, we rely on the connection between case-crossover and time-series methods to illustrate model-checking procedures from log-linear model diagnostics for time-stratified case-crossover analyses. Additionally, we compare the relative performance of the time-stratified case-crossover approach to time-series methods under 3 simulated scenarios representing different temporal patterns of daily mortality associated with air pollution in Chicago, Illinois, during 1995 and 1996. Whenever a model-be it time-series or case-crossover-fails to account appropriately for fluctuations in time that confound the exposure, the effect estimate will be biased. It is therefore important to perform model-checking in time-stratified case-crossover analyses rather than assume the estimator is unbiased.

Effects of the length of central cancer registry operations on identification of subsequent cancers and on survival estimates.

PubMed

Qiao, Baozhen; Schymura, Maria J; Kahn, Amy R

2016-10-01

Population-based cancer survival analyses have traditionally been based on the first primary cancer. Recent studies have brought this practice into question, arguing that varying registry reference dates affect the ability to identify earlier cancers, resulting in selection bias. We used a theoretical approach to evaluate the extent to which the length of registry operations affects the classification of first versus subsequent cancers and consequently survival estimates. Sequence number central was used to classify tumors from the New York State Cancer Registry, diagnosed 2001-2010, as either first primaries (value=0 or 1) or subsequent primaries (≥2). A set of three sequence numbers, each based on an assumed reference year (1976, 1986 or 1996), was assigned to each tumor. Percent of subsequent cancers was evaluated by reference year, cancer site and age. 5-year relative survival estimates were compared under four different selection scenarios. The percent of cancer cases classified as subsequent primaries was 15.3%, 14.3% and 11.2% for reference years 1976, 1986 and 1996, respectively; and varied by cancer site and age. When only the first primary was included, shorter registry operation time was associated with slightly lower 5-year survival estimates. When all primary cancers were included, survival estimates decreased, with the largest decreases seen for the earliest reference year. Registry operation length affected the identification of subsequent cancers, but the overall effect of this misclassification on survival estimates was small. Survival estimates based on all primary cancers were slightly lower, but might be more comparable across registries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Enrichment of OpenStreetMap Data Completeness with Sidewalk Geometries Using Data Mining Techniques.

PubMed

Mobasheri, Amin; Huang, Haosheng; Degrossi, Lívia Castro; Zipf, Alexander

2018-02-08

Tailored routing and navigation services utilized by wheelchair users require certain information about sidewalk geometries and their attributes to execute efficiently. Except some minor regions/cities, such detailed information is not present in current versions of crowdsourced mapping databases including OpenStreetMap. CAP4Access European project aimed to use (and enrich) OpenStreetMap for making it fit to the purpose of wheelchair routing. In this respect, this study presents a modified methodology based on data mining techniques for constructing sidewalk geometries using multiple GPS traces collected by wheelchair users during an urban travel experiment. The derived sidewalk geometries can be used to enrich OpenStreetMap to support wheelchair routing. The proposed method was applied to a case study in Heidelberg, Germany. The constructed sidewalk geometries were compared to an official reference dataset ("ground truth dataset"). The case study shows that the constructed sidewalk network overlays with 96% of the official reference dataset. Furthermore, in terms of positional accuracy, a low Root Mean Square Error (RMSE) value (0.93 m) is achieved. The article presents our discussion on the results as well as the conclusion and future research directions.

Selection and validation of reference genes for qRT-PCR analysis during biological invasions: The thermal adaptability of Bemisia tabaci MED.

PubMed

Dai, Tian-Mei; Lü, Zhi-Chuang; Liu, Wan-Xue; Wan, Fang-Hao

2017-01-01

The Bemisia tabaci Mediterranean (MED) cryptic species has been rapidly invading to most parts of the world owing to its strong ecological adaptability, which is considered as a model insect for stress tolerance studies under rapidly changing environments. Selection of a suitable reference gene for quantitative stress-responsive gene expression analysis based on qRT-PCR is critical for elaborating the molecular mechanisms of thermotolerance. To obtain accurate and reliable normalization data in MED, eight candidate reference genes (β-act, GAPDH, β-tub, EF1-α, GST, 18S, RPL13A and α-tub) were examined under various thermal stresses for varied time periods by using geNorm, NormFinder and BestKeeper algorithms, respectively. Our results revealed that β-tub and EF1-α were the best reference genes across all sample sets. On the other hand, 18S and GADPH showed the least stability for all the samples studied. β-act was proved to be highly stable only in case of short-term thermal stresses. To our knowledge this was the first comprehensive report on validation of reference genes under varying temperature stresses in MED. The study could expedite particular discovery of thermotolerance genes in MED. Further, the present results can form the basis of further research on suitable reference genes in this invasive insect and will facilitate transcript profiling in other invasive insects.

Risk factors for microbial keratitis with contemporary contact lenses: a case-control study.

PubMed

Dart, J K G; Radford, C F; Minassian, D; Verma, S; Stapleton, F

2008-10-01

To assess the relative risks (RR) of microbial keratitis (MK) for contemporary contact lens (CL) types and wearing schedules. A 2-year prospective case-control study begun in December 2003. Cases were 367 CL wearers attending Moorfields Eye Hospital with proven or presumed MK. Controls were 1069 hospital controls, who were CL wearers with a disorder unrelated to CL wear, and 639 population-based controls who were CL wearers randomly selected from the Moorfields catchment area. Hospital patients completed a self-administered questionnaire; population-based controls were interviewed by telephone. Multivariate analysis was done both for all cases of MK, and for the moderate and severe MK subgroups alone. The RR for developing MK, and vision loss, for all lens types compared with planned replacement soft lenses (the referent). Compared with planned replacement soft lenses (the referent), the RR of MK was significantly increased with daily disposable (DD) CLs (RR, 1.56x [95% confidence interval (CI), 1.1-2.1]; P = 0.009) and differed between different brands of DD lens, was reduced for rigid lenses (RR, 0.16x [95% CI, 0.06-0.4]; P<0.001), and no different for silicone hydrogel or other types of soft lens. Although the risk of MK was higher overall among DD lens users, the risk of vision loss was less than for planned replacement soft CL users (P = 0.05); no DD lens users lost vision to the level of >or=20/40. The RR for overnight wear, for any lens type, was 5.4 times higher (95% CI, 3.3-10.9; P<0.001). Comparison of the DD soft CL types with planned replacement soft lenses (the referent), showed significant differences between brands for the risk of MK. The risk of MK has not been reduced in users of DD and silicone hydrogel CLs. However, vision loss is less likely to occur in DD than in reusable soft CL users. Different brands of CL may be associated with significantly different risks of keratitis; understanding these differences should lead to the development of safer soft lenses. These findings suggest that lens/ocular surface interactions may be more important in the development of corneal infection than oxygen levels and CL case contamination.

Effects of the choice of reference on the selectivity of a multi-contact nerve cuff electrode.

PubMed

Koh, Ryan G L; Zariffa, Jose

2016-08-01

Tripolar referencing is typically used in nerve cuff electrode recordings due to its ability to maximize the signal-to-noise ratio of contacts at the centre, but this may not be the optimal choice for a multi-contact nerve cuff consisting of contacts in off-centre rings. We conducted a simulation study to compare the effects of 3 different reference types on the recording selectivity of a multi-contact nerve cuff: the tripolar reference (TPR), common average reference (CAR), and multiple tripolar references based on consecutive groups of 3 rings (cTPR). For this purpose, we introduce a novel measure called the contact information metric (CIM). Selectivity was tested in 2 noise settings, one in which white Gaussian noise was added inside the nerve cuff electrode and the other in which electromyogram (EMG) noise was added outside the nerve cuff electrode. The mean CIMs values calculated for the best 8 contacts were 3.42±6.25, 2.70±3.37, and 3.65±1.90 for the TPR, the CAR and the cTPR, respectively, in the case of EMG noise added outside the nerve cuff electrode. This study shows that the use of cTPR reference is the optimal choice for selectivity when using a multi-contact nerve cuff electrode which contains off-centre rings.

Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: a case-referent study in Nepal.

PubMed

Kc, Ashish; Wrammert, Johan; Clark, Robert B; Ewald, Uwe; Målqvist, Mats

2016-08-19

Newborns are at the greatest risk for dying during the intrapartum period, including labor and delivery, and the first day of life. Fetal heart rate monitoring (FHRM) and partogram use to track labor progress are evidence-based techniques that can help to identify maternal and fetal risk factors so that these can be addressed early. The objective of this study was to assess health worker adherence to protocols for FHRM and partogram use during the intrapartum period, and to assess the association between adherence and intrapartum stillbirth in a tertiary hospital of Nepal. A case-referent study was conducted over a 15-month period. Cases included all intrapartum stillbirths, while 20 % of women with live births were randomly selected on admission to make up the referent population. The frequency of FHRM and the use of partogram were measured and their association to intrapartum stillbirth was assessed using logistic regression analysis. During the study period, 4,476 women with live births were enrolled as referents and 136 with intrapartum stillbirths as cases. FHRM every 30 min was only completed in one-fourth of the deliveries, and labor progress was monitored using a partogram in just over half. With decreasing frequency of FHRM, there was an increased risk of intrapartum stillbirth; FHRM at intervals of more than 30 min resulted in a four-fold risk increase for intrapartum stillbirth (aOR 4.17, 95 % CI 2.0-8.7), and the likelihood of intrapartum stillbirth increased seven times if FHRM was performed less than every hour or not at all (aOR 7.38, 95 % CI 3.5-15.4). Additionally, there was a three-fold increased risk of intrapartum stillbirth if the partogram was not used (aOR 3.31, 95 % CI 2.0-5.4). The adherence to FHRM and partogram use was inadequate for monitoring intrapartum progress in a tertiary hospital of Nepal. There was an increased risk of intrapartum stillbirth when fetal heart rate was inadequately monitored and when the progress of labor was not monitored using a partogram. Further exploration is required in order to determine and understand the barriers to adherence; and further, to develop tools, techniques and interventions to prevent intrapartum stillbirth. ISRCTN97846009 .

Bioequivalence studies for 2 different strengths of irbesartan/hydrochlorothiazide combination in healthy volunteers: 300/25 mg and 300/12.5 mg film-coated tablets.

PubMed

Cánovas, M; Cabré, F; Polonio, F

2014-05-01

Two bioequivalence studies of irbesartan (CAS 138402-11-6) and hydrochlorothiazide (CAS 58-93-5) combination at 300/12.5 mg and 300/25 mg strengths were carried out in order to assess the bioequivalence of these film-coated tablet formulations in comparison with the marketed reference formulations.Both studies were performed with 30 healthy volunteers according to an open label, randomized, 2-period, 2-sequence, crossover, single dose and fasting conditions design. In each study, test and reference formulations were administered in 2 treatment days, separated by a washout period of 7 days. Blood samples were drawn up to 72 h following drug administration in case of irbesartan and up to 24 h in case of hydrochlorothiazide. Plasma concentrations of both analytes were obtained by a validated HPLC method using MS/MS detection. Log-transformed AUC0-t and Cmax values were tested for bioequivalence based on the ratios of the geometric LSmeans (test/reference).For both studies, the 90% confidence intervals of the geometric LSmean values for the test/reference ratios for AUC0-t [(irbesartan: 300/12.5 mgstrength: 95.33-111.74%. 300/25 mg strength: 91.27-103.93%) (hydrochlorothiazide: 300/12.5 mg strength: 99.63-107.50%. 300/25 mg strength: 95.72-102.24%)] and Cmax [(irbesartan: 300/12.5 mg strength: 98.73-115.03%. 300/25 mg strength: 97.27-112.12%) (hydrochlorothiazide: 300/12.5 mg strength: 97.34-112.06%. 300/25 mg strength: 93.29-106.38%)] were within the bio-equivalence acceptance range of 80-125%.According to the European Guideline on the Investigation of Bioequivalence it may be therefore concluded that both test formulations are bioequivalent to the corresponding reference formulations. Overall, it was judged that both studies were conducted with a good tolerance of the subjects to study drugs. © Georg Thieme Verlag KG Stuttgart · New York.

Discovery of previously undetected intellectual disability by psychological assessment: a study of consecutively referred child and adolescent psychiatric inpatients.

PubMed

Pogge, David L; Stokes, John; Buccolo, Martin L; Pappalardo, Stephen; Harvey, Philip D

2014-07-01

Intellectual disability is associated with an increased risk of behavioral disturbances and also complicates their treatment. Despite increases in the sophistication of medical detection of early risk for intellectual disability, there is remarkably little data about the detection of intellectual disability in cases referred for psychiatric treatment. In this study, we used a 10-year sample of 23,629 consecutive child and adolescent admissions (ages between 6 and 17) to inpatient psychiatric treatment. Eleven percent (n=2621) of these cases were referred for psychological assessment and were examined with a general measure of intellectual functioning (i.e., WISC-IV). Of these cases, 16% had Full Scale IQs below 70. Of the cases whose therapists then referred them for formal assessment of their adaptive functioning (i.e., ABAS-II) 81% were found to have composite scores below 70 as well. Only one of the cases whose Full Scale IQ was less than 70 had a referral diagnosis of intellectual disability. Cases with previously undetected intellectual disability were found to be significantly more likely to have a diagnosis of a psychotic disorder and less likely to have a diagnosis of mood disorder than cases with IQs over 70. Disruptive behavior disorder diagnoses did not differ as a function of intellectual performance. These data suggest a high rate of undetected intellectual disability in cases with a psychiatric condition serious enough to require hospitalization and this raises the possibility that many such cases may be misdiagnosed, the basis of their problems may be misconceptualized, and they may be receiving treatments that do not take into account their intellectual level. Copyright © 2014 Elsevier Ltd. All rights reserved.

An Elder Abuse Assessment Team in an Acute Hospital Setting.

ERIC Educational Resources Information Center

The Beth Israel Hospital Elder Assessment Team

1986-01-01

Describes a hospital-based multidisciplinary team designed to assess and respond to cases of suspected abuse or neglect of elders from both institutional and community settings. Presence of the team has increased the hospital staff's awareness of elder abuse and neglect, as well as their willingness to refer suspected cases for further assessment.…

Sex and Sexuality and HIV

MedlinePlus

... Education Home HIV Meds Updates Online Courses (CME) Case Studies Journal Articles Glossary Quick References Quick References Home ... against HIV: oral contraceptive ("the pill") injectable contraceptive (shot) contraceptive implant IUD (intrauterine device) emergency contraception ("morning- ...

A numerical comparison of discrete Kalman filtering algorithms: An orbit determination case study

NASA Technical Reports Server (NTRS)

Thornton, C. L.; Bierman, G. J.

1976-01-01

The numerical stability and accuracy of various Kalman filter algorithms are thoroughly studied. Numerical results and conclusions are based on a realistic planetary approach orbit determination study. The case study results of this report highlight the numerical instability of the conventional and stabilized Kalman algorithms. Numerical errors associated with these algorithms can be so large as to obscure important mismodeling effects and thus give misleading estimates of filter accuracy. The positive result of this study is that the Bierman-Thornton U-D covariance factorization algorithm is computationally efficient, with CPU costs that differ negligibly from the conventional Kalman costs. In addition, accuracy of the U-D filter using single-precision arithmetic consistently matches the double-precision reference results. Numerical stability of the U-D filter is further demonstrated by its insensitivity of variations in the a priori statistics.

Validity of administrative data claim-based methods for identifying individuals with diabetes at a population level.

PubMed

Southern, Danielle A; Roberts, Barbara; Edwards, Alun; Dean, Stafford; Norton, Peter; Svenson, Lawrence W; Larsen, Erik; Sargious, Peter; Lau, David C W; Ghali, William A

2010-01-01

This study assessed the validity of a widely-accepted administrative data surveillance methodology for identifying individuals with diabetes relative to three laboratory data reference standard definitions for diabetes. We used a combination of linked regional data (hospital discharge abstracts and physician data) and laboratory data to test the validity of administrative data surveillance definitions for diabetes relative to a laboratory data reference standard. The administrative discharge data methodology includes two definitions for diabetes: a strict administrative data definition of one hospitalization code or two physician claims indicating diabetes; and a more liberal definition of one hospitalization code or a single physician claim. The laboratory data, meanwhile, produced three reference standard definitions based on glucose levels +/- HbA1c levels. Sensitivities ranged from 68.4% to 86.9% for the administrative data definitions tested relative to the three laboratory data reference standards. Sensitivities were higher for the more liberal administrative data definition. Positive predictive values (PPV), meanwhile, ranged from 53.0% to 88.3%, with the liberal administrative data definition producing lower PPVs. These findings demonstrate the trade-offs of sensitivity and PPV for selecting diabetes surveillance definitions. Centralized laboratory data may be of value to future surveillance initiatives that use combined data sources to optimize case detection.

Occupational UV-Exposure is a Major Risk Factor for Basal Cell Carcinoma: Results of the Population-Based Case-Control Study FB-181.

PubMed

Schmitt, Jochen; Haufe, Eva; Trautmann, Freya; Schulze, Hans-Joachim; Elsner, Peter; Drexler, Hans; Bauer, Andrea; Letzel, Stephan; John, Swen Malte; Fartasch, Manigé; Brüning, Thomas; Seidler, Andreas; Dugas-Breit, Susanne; Gina, Michal; Weistenhöfer, Wobbeke; Bachmann, Klaus; Bruhn, Ilka; Lang, Berenice Mareen; Bonness, Sonja; Allam, Jean Pierre; Grobe, William; Stange, Thoralf; Westerhausen, Stephan; Knuschke, Peter; Wittlich, Marc; Diepgen, Thomas Ludwig

2018-01-01

The aim of this study was to investigate the role of occupational and nonoccupational ultraviolet (UV)-exposure concerning the development of basal cell carcinoma (BCC). We undertook a population-based multicenter case-control study. Patients with first incident BCC (n = 836) were propensity score matched by age and sex to controls without skin cancer (n = 836). Sociodemographic characteristics, clinical characteristics, and lifetime UV-exposure were assessed by trained investigators. The differential estimation of occupational and nonoccupational UV-exposure dosages was based on validated instruments and established reference values. Associations were assessed using multivariable-adjusted conditional logistic regression models. Individuals with high levels of occupational UV-exposure were at significantly increased BCC-risk compared with individuals with low [odds ratio (OR) 1.84; 95% confidence interval (95% CI) 1.19 to 2.83 and moderate (OR 1.97; 95% CI 1.20 to 3.22) occupational UV-exposure. Nonoccupational UV-exposure was not independently associated with BCC. Skin cancer prevention strategies should be expanded to the occupational setting.

High activity iodine 125 endocurietherapy for recurrent skull base tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kumar, P.P.; Good, R.R.; Leibrock, L.G.

1988-04-15

Experience with endocurietherapy of skull base tumors is reviewed. We present our cases of recurrent pituitary hemangiopericytoma, radiation-induced recurrent meningioma, recurrent clival chordoma, recurrent nasopharyngeal cancer involving the cavernous sinus, and recurrent parotid carcinoma of the skull base which were all successfully retreated with high-activity 125-iodine (I-125) permanent implantation.76 references.

Stochastic model search with binary outcomes for genome-wide association studies

PubMed Central

Malovini, Alberto; Puca, Annibale A; Bellazzi, Riccardo

2012-01-01

Objective The spread of case–control genome-wide association studies (GWASs) has stimulated the development of new variable selection methods and predictive models. We introduce a novel Bayesian model search algorithm, Binary Outcome Stochastic Search (BOSS), which addresses the model selection problem when the number of predictors far exceeds the number of binary responses. Materials and methods Our method is based on a latent variable model that links the observed outcomes to the underlying genetic variables. A Markov Chain Monte Carlo approach is used for model search and to evaluate the posterior probability of each predictor. Results BOSS is compared with three established methods (stepwise regression, logistic lasso, and elastic net) in a simulated benchmark. Two real case studies are also investigated: a GWAS on the genetic bases of longevity, and the type 2 diabetes study from the Wellcome Trust Case Control Consortium. Simulations show that BOSS achieves higher precisions than the reference methods while preserving good recall rates. In both experimental studies, BOSS successfully detects genetic polymorphisms previously reported to be associated with the analyzed phenotypes. Discussion BOSS outperforms the other methods in terms of F-measure on simulated data. In the two real studies, BOSS successfully detects biologically relevant features, some of which are missed by univariate analysis and the three reference techniques. Conclusion The proposed algorithm is an advance in the methodology for model selection with a large number of features. Our simulated and experimental results showed that BOSS proves effective in detecting relevant markers while providing a parsimonious model. PMID:22534080

A method to improve visual similarity of breast masses for an interactive computer-aided diagnosis environment.

PubMed

Zheng, Bin; Lu, Amy; Hardesty, Lara A; Sumkin, Jules H; Hakim, Christiane M; Ganott, Marie A; Gur, David

2006-01-01

The purpose of this study was to develop and test a method for selecting "visually similar" regions of interest depicting breast masses from a reference library to be used in an interactive computer-aided diagnosis (CAD) environment. A reference library including 1000 malignant mass regions and 2000 benign and CAD-generated false-positive regions was established. When a suspicious mass region is identified, the scheme segments the region and searches for similar regions from the reference library using a multifeature based k-nearest neighbor (KNN) algorithm. To improve selection of reference images, we added an interactive step. All actual masses in the reference library were subjectively rated on a scale from 1 to 9 as to their "visual margins speculations". When an observer identifies a suspected mass region during a case interpretation he/she first rates the margins and the computerized search is then limited only to regions rated as having similar levels of spiculation (within +/-1 scale difference). In an observer preference study including 85 test regions, two sets of the six "similar" reference regions selected by the KNN with and without the interactive step were displayed side by side with each test region. Four radiologists and five nonclinician observers selected the more appropriate ("similar") reference set in a two alternative forced choice preference experiment. All four radiologists and five nonclinician observers preferred the sets of regions selected by the interactive method with an average frequency of 76.8% and 74.6%, respectively. The overall preference for the interactive method was highly significant (p < 0.001). The study demonstrated that a simple interactive approach that includes subjectively perceived ratings of one feature alone namely, a rating of margin "spiculation," could substantially improve the selection of "visually similar" reference images.

PH Sensor Using A LED Source In A Fibre Optic Device

NASA Astrophysics Data System (ADS)

Grattan, K. T.; Mouaziz, Z.; Selli, R. K.

1987-10-01

Fibre optic pH sensors, for use in acid-base titrations, have been developed which use two wavelengths, in one case from two LEDs and in the other an internally generated reference replaces one of the LEDs, to sense the change in absorption of an indicator dye and provide a reference channel. A description of the construction and calibrated response of these inexpensive sensing devices is given.

Enhanced Positioning Algorithm of ARPS for Improving Accuracy and Expanding Service Coverage

PubMed Central

Lee, Kyuman; Baek, Hoki; Lim, Jaesung

2016-01-01

The airborne relay-based positioning system (ARPS), which employs the relaying of navigation signals, was proposed as an alternative positioning system. However, the ARPS has limitations, such as relatively large vertical error and service restrictions, because firstly, the user position is estimated based on airborne relays that are located in one direction, and secondly, the positioning is processed using only relayed navigation signals. In this paper, we propose an enhanced positioning algorithm to improve the performance of the ARPS. The main idea of the enhanced algorithm is the adaptable use of either virtual or direct measurements of reference stations in the calculation process based on the structural features of the ARPS. Unlike the existing two-step algorithm for airborne relay and user positioning, the enhanced algorithm is divided into two cases based on whether the required number of navigation signals for user positioning is met. In the first case, where the number of signals is greater than four, the user first estimates the positions of the airborne relays and its own initial position. Then, the user position is re-estimated by integrating a virtual measurement of a reference station that is calculated using the initial estimated user position and known reference positions. To prevent performance degradation, the re-estimation is performed after determining its requirement through comparing the expected position errors. If the navigation signals are insufficient, such as when the user is outside of airborne relay coverage, the user position is estimated by additionally using direct signal measurements of the reference stations in place of absent relayed signals. The simulation results demonstrate that a higher accuracy level can be achieved because the user position is estimated based on the measurements of airborne relays and a ground station. Furthermore, the service coverage is expanded by using direct measurements of reference stations for user positioning. PMID:27529252

Enhanced Positioning Algorithm of ARPS for Improving Accuracy and Expanding Service Coverage.

PubMed

Lee, Kyuman; Baek, Hoki; Lim, Jaesung

2016-08-12

The airborne relay-based positioning system (ARPS), which employs the relaying of navigation signals, was proposed as an alternative positioning system. However, the ARPS has limitations, such as relatively large vertical error and service restrictions, because firstly, the user position is estimated based on airborne relays that are located in one direction, and secondly, the positioning is processed using only relayed navigation signals. In this paper, we propose an enhanced positioning algorithm to improve the performance of the ARPS. The main idea of the enhanced algorithm is the adaptable use of either virtual or direct measurements of reference stations in the calculation process based on the structural features of the ARPS. Unlike the existing two-step algorithm for airborne relay and user positioning, the enhanced algorithm is divided into two cases based on whether the required number of navigation signals for user positioning is met. In the first case, where the number of signals is greater than four, the user first estimates the positions of the airborne relays and its own initial position. Then, the user position is re-estimated by integrating a virtual measurement of a reference station that is calculated using the initial estimated user position and known reference positions. To prevent performance degradation, the re-estimation is performed after determining its requirement through comparing the expected position errors. If the navigation signals are insufficient, such as when the user is outside of airborne relay coverage, the user position is estimated by additionally using direct signal measurements of the reference stations in place of absent relayed signals. The simulation results demonstrate that a higher accuracy level can be achieved because the user position is estimated based on the measurements of airborne relays and a ground station. Furthermore, the service coverage is expanded by using direct measurements of reference stations for user positioning.

Systematic review of serum steroid reference intervals developed using mass spectrometry.

PubMed

Tavita, Nevada; Greaves, Ronda F

2017-12-01

The aim of this study was to perform a systematic review of the published literature to determine the available serum/plasma steroid reference intervals generated by mass spectrometry (MS) methods across all age groups in healthy subjects and to suggest recommendations to achieve common MS based reference intervals for serum steroids. MEDLINE, EMBASE and PubMed databases were used to conduct a comprehensive search for English language, MS-based reference interval studies for serum/plasma steroids. Selection of steroids to include was based on those listed in the Royal College of Pathologists of Australasia Quality Assurance Programs, Chemical Pathology, Endocrine Program. This methodology has been registered onto the PROSPERO International prospective register of systematic reviews (ID number: CRD42015029637). After accounting for duplicates, a total of 60 manuscripts were identified through the search strategy. Following critical evaluation, a total of 16 studies were selected. Of the 16 studies, 12 reported reference intervals for testosterone, 11 for 17 hydroxy-progesterone, nine for androstenedione, six for cortisol, three for progesterone, two for dihydrotestosterone and only one for aldosterone and dehydroepiandrosterone sulphate. No studies established MS-based reference intervals for oestradiol. As far as we are aware, this report provides the first comparison of the peer reviewed literature for serum/plasma steroid reference intervals generated by MS-based methods. The reference intervals based on these published studies can be used to inform the process to develop common reference intervals, and agreed reporting units for mass spectrometry based steroid methods. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Modelling of occupational respirable crystalline silica exposure for quantitative exposure assessment in community-based case-control studies.

PubMed

Peters, Susan; Vermeulen, Roel; Portengen, Lützen; Olsson, Ann; Kendzia, Benjamin; Vincent, Raymond; Savary, Barbara; Lavoué, Jérôme; Cavallo, Domenico; Cattaneo, Andrea; Mirabelli, Dario; Plato, Nils; Fevotte, Joelle; Pesch, Beate; Brüning, Thomas; Straif, Kurt; Kromhout, Hans

2011-11-01

We describe an empirical model for exposure to respirable crystalline silica (RCS) to create a quantitative job-exposure matrix (JEM) for community-based studies. Personal measurements of exposure to RCS from Europe and Canada were obtained for exposure modelling. A mixed-effects model was elaborated, with region/country and job titles as random effect terms. The fixed effect terms included year of measurement, measurement strategy (representative or worst-case), sampling duration (minutes) and a priori exposure intensity rating for each job from an independently developed JEM (none, low, high). 23,640 personal RCS exposure measurements, covering a time period from 1976 to 2009, were available for modelling. The model indicated an overall downward time trend in RCS exposure levels of -6% per year. Exposure levels were higher in the UK and Canada, and lower in Northern Europe and Germany. Worst-case sampling was associated with higher reported exposure levels and an increase in sampling duration was associated with lower reported exposure levels. Highest predicted RCS exposure levels in the reference year (1998) were for chimney bricklayers (geometric mean 0.11 mg m(-3)), monument carvers and other stone cutters and carvers (0.10 mg m(-3)). The resulting model enables us to predict time-, job-, and region/country-specific exposure levels of RCS. These predictions will be used in the SYNERGY study, an ongoing pooled multinational community-based case-control study on lung cancer.

Case-based pedagogy as a context for collaborative inquiry in the Philippines

NASA Astrophysics Data System (ADS)

Arellano, Elvira L.; Barcenal, Tessie L.; Bilbao, Purita P.; Castellano, Merilin A.; Nichols, Sharon; Tippins, Deborah J.

2001-05-01

The purpose of this study was to investigate the potential for using case-based pedagogy as a context for collaborative inquiry into the teaching and learning of elementary science. The context for this study was the elementary science teacher preparation program at West Visayas State University on the the island of Panay in Iloilo City, the Philippines. In this context, triple linguistic conventions involving the interactions of the local Ilonggo dialect, the national language of Philipino (predominantly Tagalog) and English create unique challenges for science teachers. Participants in the study included six elementary student teachers, their respective critic teachers and a research team composed of four Filipino and two U.S. science teacher educators. Two teacher-generated case narratives serve as the centerpiece for deliberation, around which we highlight key tensions that reflect both the struggles and positive aspects of teacher learning that took place. Theoretical perspectives drawn from assumptions underlying the use of case-based pedagogy and scholarship surrounding the community metaphor as a referent for science education curriculum inquiry influenced our understanding of tensions at the intersection of re-presentation of science, authority of knowledge, and professional practice, at the intersection of not shared language, explicit moral codes, and indigenization, and at the intersection of identity and dilemmas in science teaching. Implications of this study are discussed with respect to the building of science teacher learning communities in both local and global contexts of reform.

North American Multicenter Volumetric CT Study for Clinical Staging of Malignant Pleural Mesothelioma: Feasibility and Logistics of Setting Up a Quantitative Imaging Study.

PubMed

Gill, Ritu R; Naidich, David P; Mitchell, Alan; Ginsberg, Michelle; Erasmus, Jeremy; Armato, Samuel G; Straus, Christopher; Katz, Sharyn; Patios, Demetrois; Richards, William G; Rusch, Valerie W

2016-08-01

Clinical tumor (T), node, and metastasis staging is based on a qualitative assessment of features defining T descriptors and has been found to be suboptimal for predicting the prognosis of patients with malignant pleural mesothelioma (MPM). Previous work suggests that volumetric computed tomography (VolCT) is prognostic and, if found practical and reproducible, could improve clinical MPM classification. Six North American institutions electronically submitted clinical, pathologic, and imaging data on patients with stages I to IV MPM to an established multicenter database and biostatistical center. Two reference radiologists blinded to clinical data independently reviewed the scans; calculated clinical T, node, and metastasis stage by standard criteria; performed semiautomated tumor volume calculations using commercially available software; and submitted the findings to the biostatistical center. Study end points included the feasibility of a multi-institutional VolCT network, concordance of independent VolCT assessments, and association of VolCT with pathological T classification. Of 164 submitted cases, 129 were evaluated by both reference radiologists. Discordant clinical staging of most cases confirmed the inadequacy of current criteria. The overall correlation between VolCT estimates was good (Spearman correlation 0.822), but some were significantly discordant. Root cause analysis of the most discordant estimates identified four common sources of variability. Despite these limitations, median tumor volume estimates were similar within subgroups of cases representing each pathological T descriptor and increased monotonically for each reference radiologist with increasing pathological T status. The good correlation between VolCT estimates obtained for most cases reviewed by two independent radiologists and qualitative association of VolCT with pathological T status combine to encourage further study. The identified sources of user error will inform design of a follow-up prospective trial to more formally assess interobserver variability of VolCT and its potential contribution to clinical MPM staging. Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

The pattern of self-harm in Fars Province in South Iran: A population-based study.

PubMed

Gholamzadeh, Saeid; Zahmatkeshan, Mozhghan; Zarenezhad, Mohammad; Ghaffari, Elaheh; Hoseni, Sanaz

2017-10-01

Non-suicidal self-harm includes cutting, scratching, burning and minor overdosing. There have been few studies that have examined the rate and pattern of self-harm among different individuals of the society. We performed a population-based study to determine different aspects of non-suicidal self-harm in cases referred to legal medicine organization of Fars Province and south Iran. In a population-based longitudinal survey, we applied data from cases referred to legal medicine organization of Fars province. The survey included questions about the history, method, frequency, age of onset and help-seeking for non-suicidal self-harm. The data about non-suicidal self-harm were collected since 2007 to 2011 and analyzed using students' T-test for continuous data and χ 2 for binary or categorical data using SPSS ver. 21.0. Totally 2166 individuals were diagnosed who had ever harmed themselves. Self-injuries such as cutting, scratching and self-hitting were the most common forms of non-suicidal self-harm (83.2%). The mean age of onset was 25.7 ± 2.6 years. Self-injury was more frequent in males and individuals with lower education levels mostly unemployed. The most frequent injury site was posterior side of the body for example shoulders (157; 9.8%) and the most type of the injury was bruise in 398(55.26%) cases. Hard objects (1197; 55.26%) were the most used devices for self-injury followed by cutting and sharp devices. Among those who reported non-suicidal self-harm, 56% had sought help while self-injury. We found a high prevalence of non-suicidal self-harm in different individuals of the society in Fars province since 2007 to 2011. Many mental-health symptoms as well as legal and financial gains should be evaluated for any association with this behavior. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Managing research and surveillance projects in real-time with a novel open-source eManagement tool designed for under-resourced countries.

PubMed

Steiner, Andreas; Hella, Jerry; Grüninger, Servan; Mhalu, Grace; Mhimbira, Francis; Cercamondi, Colin I; Doulla, Basra; Maire, Nicolas; Fenner, Lukas

2016-09-01

A software tool is developed to facilitate data entry and to monitor research projects in under-resourced countries in real-time. The eManagement tool "odk_planner" is written in the scripting languages PHP and Python. The odk_planner is lightweight and uses minimal internet resources. It was designed to be used with the open source software Open Data Kit (ODK). The users can easily configure odk_planner to meet their needs, and the online interface displays data collected from ODK forms in a graphically informative way. The odk_planner also allows users to upload pictures and laboratory results and sends text messages automatically. User-defined access rights protect data and privacy. We present examples from four field applications in Tanzania successfully using the eManagement tool: 1) clinical trial; 2) longitudinal Tuberculosis (TB) Cohort Study with a complex visit schedule, where it was used to graphically display missing case report forms, upload digitalized X-rays, and send text message reminders to patients; 3) intervention study to improve TB case detection, carried out at pharmacies: a tablet-based electronic referral system monitored referred patients, and sent automated messages to remind pharmacy clients to visit a TB Clinic; and 4) TB retreatment case monitoring designed to improve drug resistance surveillance: clinicians at four public TB clinics and lab technicians at the TB reference laboratory used a smartphone-based application that tracked sputum samples, and collected clinical and laboratory data. The user friendly, open source odk_planner is a simple, but multi-functional, Web-based eManagement tool with add-ons that helps researchers conduct studies in under-resourced countries. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Introducing an Equal Rights Framework for Older Persons in Residential Care

PubMed Central

Jönson, Håkan; Harnett, Tove

2016-01-01

This article reconceptualizes residential care for older persons by introducing a framework developed from a rights-based principle of disability policies: the normalization principle. This principle is part of the social model and states that society should make available for people who have impairments living conditions that are as close as possible to those of “others.” Using the framework on the case of eldercare in Sweden shows that although disability policies have used people without impairments as a comparative (external) reference group for claiming rights, eldercare policies use internal reference groups, basing comparisons on other care users. The article highlights the need for external comparisons in eldercare and suggests that the third age, which so far has been a normative reference group for older people, could be a comparative reference group when older persons in need of care claim rights to equal conditions. PMID:26035884

Case identification of depression in patients with chronic physical health problems: a diagnostic accuracy meta-analysis of 113 studies

PubMed Central

Meader, Nicholas; Mitchell, Alex J; Chew-Graham, Carolyn; Goldberg, David; Rizzo, Maria; Bird, Victoria; Kessler, David; Packham, Jon; Haddad, Mark; Pilling, Stephen

2011-01-01

Background Depression is more likely in patients with chronic physical illness, and is associated with increased rates of disability and mortality. Effective treatment of depression may reduce morbidity and mortality. The use of two stem questions for case finding in diabetes and coronary heart disease is advocated in the Quality and Outcomes Framework, and has become normalised into primary care. Aim To define the most effective tool for use in consultations to detect depression in people with chronic physical illness. Design Meta-analysis. Method The following data sources were searched: CENTRAL, CINAHL, Embase, HMIC, MEDLINE, PsycINFO, Web of Knowledge, from inception to July 2009. Three authors selected studies that examined identification tools and used an interview-based ICD (International Classification of Diseases) or DSM (Diagnostic and statistical Manual of Mental Disorders) diagnosis of depression as reference standard. At least two authors independently extracted study characteristics and outcome data and assessed methodological quality. Results A total of 113 studies met the eligibility criteria, providing data on 20 826 participants. It was found that two stem questions, PHQ-9 (Patient Health Questionnaire), the Zung, and GHQ-28 (General Health Questionnaire) were the optimal measures for case identification, but no method was sufficiently accurate to recommend as a definitive case-finding tool. Limitations were the moderate-to-high heterogeneity for most scales and the facts that few studies used ICD diagnoses as the reference standard, and that a variety of methods were used to determine DSM diagnoses. Conclusion Assessing both validity and ease of use, the two stem questions are the preferred method. However, clinicians should not rely on the two-questions approach alone, but should be confident to engage in a more detailed clinical assessment of patients who score positively. PMID:22137418

Evaluating the effectiveness of infant mental health enhanced case management for dependency populations.

PubMed

Congdon, David

2010-10-01

Children who are receiving services for abuse and neglect are likely to have reduced developmental levels and are less prepared for success in school as a result. The progress of 144 children receiving services from The Children's Home Society of Florida was tracked with half being randomly assigned to a control group and half to an experimental group receiving enhanced infant mental health oriented case management services from two social work professionals in each of two locations in Tallahassee and West Palm Beach Florida. Those receiving enhanced case management showed significantly higher results in the following areas: more visits with their parents (for those removed from the family home), more service referrals, more completed assessments for services, more services based on the assessments they received, and more success in completing goals of treatment for which they were referred. Their parents had more contact with professionals to whom they were referred and had more success in completing goals of the treatment for which they were referred. Children who received intensive case management also showed improvement in their developmental skills related to problem solving from inception to completion of services. Implications for further research are considered.

Knowledge based systems: A critical survey of major concepts, issues and techniques. Visuals

NASA Technical Reports Server (NTRS)

Dominick, Wayne D. (Editor); Kavi, Srinu

1984-01-01

This Working Paper Series entry represents a collection of presentation visuals associated with the companion report entitled, Knowledge Based Systems: A Critical Survey of Major Concepts, Issues, and Techniques, USL/DBMS NASA/RECON Working Paper Series report number DBMS.NASA/RECON-9. The objectives of the report are to: examine various techniques used to build the KBS; to examine at least one KBS in detail, i.e., a case study; to list and identify limitations and problems with the KBS; to suggest future areas of research; and to provide extensive reference materials.

The National Biological Information Infrastructure: Coming of age

USGS Publications Warehouse

Cotter, G.; Frame, M.; Sepic, R.; Zolly, L.

2000-01-01

Coordinated by the US Geological Survey, the National Biological Information Infrastructure (NBII) is a Web-based system that provides increased access to data and information on the nation's biological resources. The NBII can be viewed from a variety of perspectives. This article - an individual case study and not a broad survey with extensive references to the literature - addresses the structure of the NBII related to thematic sections, infrastructure sections and place-based sections, and other topics such as the Integrated Taxonomic Information System (one of our more innovative tools) and the development of our controlled vocabulary.

What is driving rates of social policy preliminary references to the CJEU? Evidence from the United Kingdom and France

PubMed Central

Sigafoos, Jennifer

2013-01-01

Preliminary references to the Court of Justice for the European Union are unevenly distributed across the EU, creating differing access to justice for European citizens. This study presents case studies of the UK and France, exploring factors affecting rates of social policy preliminary references from 1996–2009. The UK had a rate twice that of France. What accounts for this difference? Analysis of documentary evidence and 25 expert interviews help to explain the differing rates. Themes were related to policy, structural factors and the agency of actors. In the UK, policy themes are the free movement of persons and the ‘Right to Reside’ test. Legal aid and legal NGOs help individuals access the Court and drive test case strategies. In France, a high degree of dualisation in the welfare state creates an insider/outsider dynamic. Coupled with the resistance of courts and a lack of comparable actors to drive preliminary references, this contributes to a lower rate of references. PMID:23565042

A Zeus++ Code Tool, a Method for Implementing Same, and Storage Medium Storing Computer Readable Instructions for Instantiating the Zeus++ Code Tool

DTIC Science & Technology

1999-12-01

applications, it should be understood that the invention is not limited thereto. Those having - 9 - Navy Case No. 79694 ordinary skill in the art and access...processing. It should also be mentioned that Tecplot is a commercial plotting software package produced by Amtec Engineering, Inc. The following...conditions) 7. Ch (base on edge conditions) -43- 10 Navy Case No. 79694 8. Ch (base on reference conditions) 9 . Momentum thickness 10. Displacement

Novelty and Foreseeing Research Trends: The Case of Astrophysics and Astronomy

NASA Astrophysics Data System (ADS)

Varga, Attila

2018-05-01

Metrics based on reference lists of research articles or on keywords have been used to predict citation impact. The concept behind such metrics is that original ideas stem from the reconfiguration of the structure of past knowledge, and therefore atypical combinations in the reference lists, keywords, or classification codes indicate future high-impact research. The current paper serves as an introduction to this line of research for astronomers and also addresses some of the methodological questions in this field of innovation studies. It is still not clear if the choice of particular indexes, such as references to journals, articles, or specific bibliometric classification codes affects the relationship between atypical combinations and citation impact. To understand more aspects of the innovation process, a new metric has been devised to measure to what extent researchers are able to anticipate the changing combinatorial trends of the future. Results show that the variant of the latter anticipation scores that is based on paper combinations is a good predictor of the future citation impact of scholarly works. The study also shows that the effects of tested indexes vary with the aggregation levels that were used to construct them. A detailed analysis of combinatorial novelty in the field reveals that certain sub-fields of astronomy and astrophysics have different roles in the reconfiguration of past knowledge.

Conducting a surveillance problem analysis on poor feedback from Reference Laboratory, Liberia, February 2016.

PubMed

Frimpong, Joseph Asamoah; Amo-Addae, Maame Pokuah; Adewuyi, Peter Adebayo; Hall, Casey Daniel; Park, Meeyoung Mattie; Nagbe, Thomas Knue

2017-01-01

The laboratory plays a major role in surveillance, including confirming the start and end of an outbreak. Knowing the causative agent for an outbreak informs the development of response strategies and management plans for a public health event. However, issues and challenges may arise that limit the effectiveness or efficiency of laboratories in surveillance. This case study applies a systematic approach to analyse gaps in laboratory surveillance, thereby improving the ability to mitigate these gaps. Although this case study concentrates on factors resulting in poor feedback from the laboratory, practise of this general approach to problem analysis will confer skills required in analysing most public health issues. This case study was developed based on a report submitted by the district surveillance officer in Grand Bassa County, Liberia, as a resident of the Liberian Frontline Field Epidemiology Training Program in 2016. This case study will serve as a training tool to reinforce lectures on surveillance problem analysis using the fishbone approach. It is designed for public health training in a classroom setting and can be completed within 2 hours 30 minutes.

Genetics Home Reference: L1 syndrome

MedlinePlus

... X-linked hydrocephalus: evidence for closely related clinical entities of unknown molecular bases. Acta Neuropathol. 2013 Sep; ... F. Three cases with L1 syndrome and two novel mutations in the L1CAM gene. Eur J Pediatr. ...

Cost Analysis of Integrative Inpatient Treatment Based on DRG Data: The Example of Anthroposophic Medicine

PubMed Central

Heinz, Jürgen; Fiori, Wolfgang; Heusser, Peter

2013-01-01

Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually. PMID:23431346

MPT64 antigen detection test improves routine diagnosis of extrapulmonary tuberculosis in a low-resource setting: A study from the tertiary care hospital in Zanzibar.

PubMed

Jørstad, Melissa Davidsen; Marijani, Msafiri; Dyrhol-Riise, Anne Ma; Sviland, Lisbet; Mustafa, Tehmina

2018-01-01

Extrapulmonary tuberculosis (EPTB) is a diagnostic challenge. An immunochemistry-based MPT64 antigen detection test (MPT64 test) has reported higher sensitivity in the diagnosis of EPTB compared with conventional methods. The objective of this study was to implement and evaluate the MPT64 test in routine diagnostics in a low-resource setting. Patients with presumptive EPTB were prospectively enrolled at Mnazi Mmoja Hospital, Zanzibar, and followed to the end of treatment. Specimens collected were subjected to routine diagnostics, GeneXpert® MTB/RIF assay and the MPT64 test. The performance of the MPT64 test was assessed using a composite reference standard, defining the patients as tuberculosis (TB) cases or non-TB cases. Patients (n = 132) were classified as confirmed TB (n = 12), probable TB (n = 34), possible TB (n = 18), non-TB (n = 62) and uncategorized (n = 6) cases. Overall, in comparison to the composite reference standard for diagnosis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the MPT64 test was 69%, 95%, 94%, 75% and 82%, respectively. The MPT64 test performance was best in TB lymphadenitis cases (n = 67, sensitivity 79%, specificity 97%) and in paediatric TB (n = 41, sensitivity 100%, specificity 96%). We show that the MPT64 test can be implemented in routine diagnostics in a low-resource setting and improves the diagnosis of EPTB, especially in TB lymphadenitis and in children.

A Novel Reference Security Model with the Situation Based Access Policy for Accessing EPHR Data.

PubMed

Gope, Prosanta; Amin, Ruhul

2016-11-01

Electronic Patient Health Record (EPHR) systems may facilitate a patient not only to share his/her health records securely with healthcare professional but also to control his/her health privacy, in a convenient and easy way even in case of emergency. In order to fulfill these requirements, it is greatly desirable to have the access control mechanism which can efficiently handle every circumstance without negotiating security. However, the existing access control mechanisms used in healthcare to regulate and restrict the disclosure of patient data are often bypassed in case of emergencies. In this article, we propose a way to securely share EPHR data under any situation including break-the-glass (BtG) without compromising its security. In this regard, we design a reference security model, which consists of a multi-level data flow hierarchy, and an efficient access control framework based on the conventional Role-Based Access Control (RBAC) and Mandatory Access Control (MAC) policies.

Offshore safety case approach and formal safety assessment of ships.

PubMed

Wang, J

2002-01-01

Tragic marine and offshore accidents have caused serious consequences including loss of lives, loss of property, and damage of the environment. A proactive, risk-based "goal setting" regime is introduced to the marine and offshore industries to increase the level of safety. To maximize marine and offshore safety, risks need to be modeled and safety-based decisions need to be made in a logical and confident way. Risk modeling and decision-making tools need to be developed and applied in a practical environment. This paper describes both the offshore safety case approach and formal safety assessment of ships in detail with particular reference to the design aspects. The current practices and the latest development in safety assessment in both the marine and offshore industries are described. The relationship between the offshore safety case approach and formal ship safety assessment is described and discussed. Three examples are used to demonstrate both the offshore safety case approach and formal ship safety assessment. The study of risk criteria in marine and offshore safety assessment is carried out. The recommendations on further work required are given. This paper gives safety engineers in the marine and offshore industries an overview of the offshore safety case approach and formal ship safety assessment. The significance of moving toward a risk-based "goal setting" regime is given.

Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone

PubMed Central

2011-01-01

Background Malaria is hyper-endemic and a major public health problem in Sierra Leone. To provide malaria treatment closer to the community, Médecins Sans Frontières (MSF) launched a community-based project where Community Malaria Volunteers (CMVs) tested and treated febrile children and pregnant women for malaria using rapid diagnostic tests (RDTs). RDT-negative patients and severely ill patients were referred to health facilities. This study sought to determine the referral rate and compliance of patients referred by the CMVs. Methods In MSF's operational area in Bo and Pujehun districts, Sierra Leone, a retrospective analysis of referral records was carried out for a period of three months. All referral records from CMVs and referral health structures were reviewed, compared and matched for personal data. The eligible study population included febrile children between three and 59 months and pregnant women in their second or third trimester with fever who were noted as having received a referral advice in the CMV recording form. Results The study results showed a total referral rate of almost 15%. During the study period 36 out of 2,459 (1.5%) referred patients completed their referral. There was a significant difference in referral compliance between patients with fever but a negative RDT and patients with signs of severe malaria. Less than 1% (21/2,442) of the RDT-negative patients with fever completed their referral compared to 88.2% (15/17) of the patients with severe malaria (RR = 0.010 95% CI 0.006 - 0.015). Conclusions In this community-based malaria programme, RDT-negative patients with fever were referred to a health structure for further diagnosis and care with a disappointingly low rate of referral completion. This raises concerns whether use of CMVs, with referral as backup in RDT-negative cases, provides adequate care for febrile children and pregnant women. To improve the referral completion in MSF's community-based malaria programme in Sierra Leone, and in similar community-based programmes, a suitable strategy needs to be defined. PMID:21496333

Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone.

PubMed

Thomson, Anna; Khogali, Mohammed; de Smet, Martin; Reid, Tony; Mukhtar, Ahmed; Peterson, Stefan; von Schreeb, Johan

2011-04-17

Malaria is hyper-endemic and a major public health problem in Sierra Leone. To provide malaria treatment closer to the community, Médecins Sans Frontières (MSF) launched a community-based project where Community Malaria Volunteers (CMVs) tested and treated febrile children and pregnant women for malaria using rapid diagnostic tests (RDTs). RDT-negative patients and severely ill patients were referred to health facilities. This study sought to determine the referral rate and compliance of patients referred by the CMVs. In MSF's operational area in Bo and Pujehun districts, Sierra Leone, a retrospective analysis of referral records was carried out for a period of three months. All referral records from CMVs and referral health structures were reviewed, compared and matched for personal data. The eligible study population included febrile children between three and 59 months and pregnant women in their second or third trimester with fever who were noted as having received a referral advice in the CMV recording form. The study results showed a total referral rate of almost 15%. During the study period 36 out of 2,459 (1.5%) referred patients completed their referral. There was a significant difference in referral compliance between patients with fever but a negative RDT and patients with signs of severe malaria. Less than 1% (21/2,442) of the RDT-negative patients with fever completed their referral compared to 88.2% (15/17) of the patients with severe malaria (RR = 0.010 95% CI 0.006 - 0.015). In this community-based malaria programme, RDT-negative patients with fever were referred to a health structure for further diagnosis and care with a disappointingly low rate of referral completion. This raises concerns whether use of CMVs, with referral as backup in RDT-negative cases, provides adequate care for febrile children and pregnant women. To improve the referral completion in MSF's community-based malaria programme in Sierra Leone, and in similar community-based programmes, a suitable strategy needs to be defined.

Case Studies of Actual and Alleged Overflights, 1930-1953. Supplement

DTIC Science & Technology

1955-08-15

the SECRET volume than would have been possible if all the case studies had been presented in the same volume, regardless of classification. The character of the intelligence mission of United States reconnaissance aircraft referred to in case studies Nos. 115-118, 120-123, and 129-131 is not precisely identified in the discussion of those

Pharmacophore-Based Similarity Scoring for DOCK

PubMed Central

2015-01-01

Pharmacophore modeling incorporates geometric and chemical features of known inhibitors and/or targeted binding sites to rationally identify and design new drug leads. In this study, we have encoded a three-dimensional pharmacophore matching similarity (FMS) scoring function into the structure-based design program DOCK. Validation and characterization of the method are presented through pose reproduction, crossdocking, and enrichment studies. When used alone, FMS scoring dramatically improves pose reproduction success to 93.5% (∼20% increase) and reduces sampling failures to 3.7% (∼6% drop) compared to the standard energy score (SGE) across 1043 protein–ligand complexes. The combined FMS+SGE function further improves success to 98.3%. Crossdocking experiments using FMS and FMS+SGE scoring, for six diverse protein families, similarly showed improvements in success, provided proper pharmacophore references are employed. For enrichment, incorporating pharmacophores during sampling and scoring, in most cases, also yield improved outcomes when docking and rank-ordering libraries of known actives and decoys to 15 systems. Retrospective analyses of virtual screenings to three clinical drug targets (EGFR, IGF-1R, and HIVgp41) using X-ray structures of known inhibitors as pharmacophore references are also reported, including a customized FMS scoring protocol to bias on selected regions in the reference. Overall, the results and fundamental insights gained from this study should benefit the docking community in general, particularly researchers using the new FMS method to guide computational drug discovery with DOCK. PMID:25229837

A DECADE TREND OF MULTIDRUG RESISTANT TUBERCULOSIS IN SÃO PAULO STATE, BRAZIL

PubMed Central

BOLLELA, Valdes Roberto; PUGA, Fernanda Guioti; MOYA, Maria Janete; ANDREA, Mauro; OLIVEIRA, Maria de Lourdes Viude

2016-01-01

SUMMARY The aim of this retrospective study was to review all the notified cases of multidrug-resistant tuberculosis (MDR-TB) in São Paulo State (Brazil), as well as to describe and discuss the clinical, microbiological and radiologic aspects in a single reference center, within the same state, from 2000 to 2012. There were 1,097 notifications of MDR-TB in São Paulo State over this period, 70% affecting men aged on average 38 years (10-77). There was a significant fall in the MDR-TB mortality rate from 30% to 8% (2000-2003 versus 2009-2012). The same trend was observed in the cases studied at the reference center. The number of notified cases increased and death rate reduced from 37.5% (2000-2005) to 3.4% (2006-2012). Among the 48 drug-resistant TB cases, 17 non-tuberculous Mycobacteria were isolated in the sputum culture of nine patients, without any clinical significance. TB and fungus co-infection was diagnosed in 15% (7/48) of these cases: three with confirmed chronic pulmonary aspergillosis and four with positive serological markers for paracoccidioidomycosis. Overall, the reports show that MDR-TB diagnosis and cure rates have increased, while the mortality rate has decreased significantly in São Paulo State including in the studied reference center. PMID:27828618

A DECADE TREND OF MULTIDRUG RESISTANT TUBERCULOSIS IN SÃO PAULO STATE, BRAZIL.

PubMed

Bollela, Valdes Roberto; Puga, Fernanda Guioti; Moya, Maria Janete; Andrea, Mauro; Oliveira, Maria de Lourdes Viude

2016-11-03

The aim of this retrospective study was to review all the notified cases of multidrug-resistant tuberculosis (MDR-TB) in São Paulo State (Brazil), as well as to describe and discuss the clinical, microbiological and radiologic aspects in a single reference center, within the same state, from 2000 to 2012. There were 1,097 notifications of MDR-TB in São Paulo State over this period, 70% affecting men aged on average 38 years (10-77). There was a significant fall in the MDR-TB mortality rate from 30% to 8% (2000-2003 versus 2009-2012). The same trend was observed in the cases studied at the reference center. The number of notified cases increased and death rate reduced from 37.5% (2000-2005) to 3.4% (2006-2012). Among the 48 drug-resistant TB cases, 17 non-tuberculous Mycobacteria were isolated in the sputum culture of nine patients, without any clinical significance. TB and fungus co-infection was diagnosed in 15% (7/48) of these cases: three with confirmed chronic pulmonary aspergillosis and four with positive serological markers for paracoccidioidomycosis. Overall, the reports show that MDR-TB diagnosis and cure rates have increased, while the mortality rate has decreased significantly in São Paulo State including in the studied reference center.

[Burning mouth caused by denture material].

PubMed

Feilzer, A J

2009-09-01

A 60-year-old man with an edentulous maxilla was referred by his dentist to an allergy clinic with complaints of burning mouth and bad taste. In the majority of cases, it is hard or impossible to detect the cause of burning mouth. In this case, ultimately the complaint could be solved by eliminating exposure to possible allergenic components of denture base resins.

Morality as the Substructure of Social Justice: Religion in Education as a Case in Point

ERIC Educational Resources Information Center

Potgieter, Ferdinand J.

2011-01-01

Moral issues and principles do not only emerge in cases of conflict among, for instance, religious communities or political parties; indeed they form the moral substructure of notions of social justice. During periods of conflict each opponent claims justice for his/her side and bases the claim on certain principles. In this article, reference is…

Operations analysis for lunar surface construction: Results of two office of exploration case studies

NASA Astrophysics Data System (ADS)

Bell, Lisa Y.; Boles, Walter; Smith, Alvin

1991-08-01

In an environment of intense competition for Federal funding, the U.S. space research community is responsible for developing a feasible, cost-effective approach to establishing a surface base on the moon to fulfill long-term Government objectives. This report presents the results of a construction operations analysis of two lunar scenarios provided by the National Aeronautics and Space Administration (NASA). Activities necessary to install the lunar base surface elements are defined and scheduled, based on the productivities and availability of the base resources allocated to the projects depicted in each scenario. The only construction project in which the required project milestones were not completed within the nominal timeframe was the initial startup phase of NASA's FY89 Lunar Evolution Case Study (LECS), primarily because this scenario did not include any Earth-based telerobotic site preparation before the arrival of the first crew. The other scenario analyzed. Reference Mission A from NASA's 90-Day Study of the Human Exploration of the Moon and Mars, did use telerobotic site preparation before the manned phase of the base construction. Details of the analysis for LECS are provided, including spreadsheets indicating quantities of work and Gantt charts depicting the general schedule for the work. This level of detail is not presented for the scenario based on the 90-Day Study because many of the projects include the same (or similar) surface elements and facilities.

Prostate cancer incidence and newly diagnosed patient profile in Spain in 2010.

PubMed

Cózar, José M; Miñana, Bernardino; Gómez-Veiga, Francisco; Rodríguez-Antolín, Alfredo; Villavicencio, Humberto; Cantalapiedra, Arancha; Pedrosa, Emilio

2012-12-01

What's known on the subject? and What does the study add? Prostate cancer (PCa) accounts for 12% of newly diagnosed cases of cancer in Europe. It is one of the most frequently diagnosed tumours in the developed world. Since the introduction of prostate specific antigen as a test for early detection of PCa, the rate of diagnosis has increased significantly and specific mortality has reduced in most western countries. Most of the data on the incidence of PCa are obtained from population-based cancer registries which frequently do not cover the whole population. This first national hospital-based PCa registry aims not only to estimate the incidence of the disease but to ascertain the clinical profile of newly diagnosed PCa patients, a useful tool for evaluating the impact of the disease and its socio-health management. • To estimate the 2010 incidence of prostate cancer (PCa) in Spain. • To describe the clinical profile of newly diagnosed cases using a nationwide hospital-based registry. • This was a national epidemiological observational study in 25 public hospitals with a specific reference population according to the National Health System. • Sociodemographic and clinical variables of all newly diagnosed, histopathologically confirmed PCa cases were collected in 2010, in the area of influence of each centre. Cases diagnosed in private practice were not collected (estimated nearly 10% in Spain). • Data monitoring was external to guarantee quality and homogeneity. • The age-standardized PCa incidence was determined based on the age distribution of the European standard population. • In all, 4087 new cases of PCa were diagnosed for a reference population of 4933940 men (21.8% of the Spanish male population). • The estimated age-standardized PCa incidence was 70.75 cases per 100000 men. • Mean age at diagnosis was 69 years; 11.6% of patients presented with tumour-related symptoms and 39.5% with LUTS. Median PSA was 8 ng/mL. Gleason score was ≤ 6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 89.8% had localized, 6.4% locally advanced and 3.8% metastatic disease. • This study on PCa incidence in Spain, a western country with intensive opportunistic PSA screening, shows that PCa is a high incidence tumour, diagnosed close to 70 years, usually asymptomatic. • Almost 40% of cases have low risk disease with a risk of over-diagnosis and over-treatment. • Around 55% of patients with intermediate or high risk disease are candidates for active therapy which may result in a reduction of cancer-specific mortality. © 2012 ASOCIACIÓN ESPANOLA UROLOGÍA.

Affective Influences in the Knowledge of Mathematics.

ERIC Educational Resources Information Center

Gomez-Chacon, Ines Maria

2000-01-01

Proposes a model to study the interaction between cognition and affect in mathematics. Develops important dimensions related to affect and cognition. Explains the importance of taking into account such dimensions in this kind of research, referring to students who are failing academically through a case study. (Contains 21 references.) (Author/ASK)

Sir William Osler's perceptions of urolithiasis and the case of the indigo calculus.

PubMed

Moran, Michael E; Das, Sakti; Rosenberg, Stuart A

2005-12-01

Sir William Osler published his textbook, The Principles and Practice of Medicine, in 1892. It became the definitive treatise on a wide variety of diseases. The section on nephrolithiasis clearly presents the etiology, pathology, symptoms, diagnosis, and treatments. What remains a mystery is the mention, under rare forms of human stones, of a type called "indigo." A search of Index Medicus starting from 1909 backward to its inception in 1879 was performed for key words "indigo," "calculus," "renal" or "bladder stones" and "indicanuria." Twelve textbooks of urology published before 1940 were scrutinized for references to indigo calculi. Only two references to indigo were found, both related to its use for treating constipation (1887 and 1891). Of the 12 textbooks, only 4 make passing reference to "indigo stones." They all mention that such calculi are very rare, but direct references to cases are lacking. One textbook references a study of blue stones from Egyptian mummies. It is unlikely that Osler's reference to an indigo calculus was taken lightly during his writing of The Principles and Practice of Medicine. The case of the indigo calculus is fascinating and perhaps enlightening if only for the source of Osler's intrigue.

Criteria-based audit to improve quality of care of foetal distress: standardising obstetric care at a national referral hospital in a low resource setting, Tanzania.

PubMed

Mgaya, Andrew H; Litorp, Helena; Kidanto, Hussein L; Nyström, Lennarth; Essén, Birgitta

2016-11-08

In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting. During 2013-2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for standard diagnosis and management of foetal distress were developed based on international and national guidelines, and literature reviews, and then, stepwise applied, in an audit cycle. During the baseline audit, substandard care was identified, and recommendations for improvement of care were proposed and implemented. The effect of the implementations was assessed by the differences in percentage of standard diagnosis and management between the baseline and re-audit, using Chi-square test or Fisher's exact test, when appropriate. In the baseline audit and re-audit, 248 and 251 deliveries with a diagnosis of foetal distress were identified and audited, respectively. The standard of diagnosis increased significantly from 52 to 68 % (p < 0.001). Standards of management improved tenfold from 0.8 to 8.8 % (p < 0.001). Improved foetal heartbeat monitoring using a Fetal Doppler was the major improvement in diagnoses, while change of position of the mother and reduced time interval from decision to perform caesarean section to delivery were the major improvements in management (all p < 0.001). Percentage of cases with substandard diagnosis and management was significantly reduced in both referred public and non-referred private patients (all p ≤ 0.01) but not in non-referred public and referred private patients. The criteria-based audit was able to detect substandard diagnosis and management of foetal distress and improved care using feedback and available resources.

Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study.

PubMed

Burmaster, Chris; Eckenrode, Brian J; Stiebel, Matthew

2016-01-01

Both traditional and progressive rotator cuff repair rehabilitation protocols often delay active motion of the shoulder for 6 weeks or more. The early inclusion of a comprehensive aquatic-assisted exercise program presents a unique approach to postoperative management. The purpose of this case study is to describe a comprehensive evidence-based, aquatic-assisted rehabilitation program following arthroscopic rotator cuff repair. A 73-year-old woman with a nonretracted, medium-size, full-thickness tear (2.5 cm) of the supraspinatus tendon underwent arthroscopic rotator cuff repair and was referred for postoperative physical therapy. The rehabilitation program was initiated at 2 weeks postoperatively and consisted of concurrent land- and aquatic-based interventions over 6 weeks for a total of 18 physical therapy visits. Improvements were made in all 5 patient-reported outcome measures that were recorded weekly over the course of care. Improvements reached or exceeded minimal detectable change levels for the Shoulder Pain and Disability Index and the Penn Shoulder Score. Her numeric pain rating scale score at rest decreased from 4/10 at the initial evaluation to 2/10 at 8 weeks postoperatively and with activity decreased from 9/10 to 6/10. Shoulder strength and range of motion values also exhibited improvement over the course of care. No adverse events occurred during the case study. This case study illustrates the safe inclusion of low-stress aquatic exercises as an early adjunct to traditional land-based rotator cuff repair rehabilitation programs in small- to medium-size repairs. Further studies are needed to determine the long-term effectiveness of adding aquatic therapy to traditional postoperative programs. © 2016 American Physical Therapy Association.

Economic implications of mercury exposure in the context of the global mercury treaty: Hair mercury levels and estimated lost economic productivity in selected developing countries.

PubMed

Trasande, Leonardo; DiGangi, Joseph; Evers, David C; Petrlik, Jindrich; Buck, David G; Šamánek, Jan; Beeler, Bjorn; Turnquist, Madeline A; Regan, Kevin

2016-12-01

Several developing countries have limited or no information about exposures near anthropogenic mercury sources and no studies have quantified costs of mercury pollution or economic benefits to mercury pollution prevention in these countries. In this study, we present data on mercury concentrations in human hair from subpopulations in developing countries most likely to benefit from the implementation of the Minamata Convention on Mercury. These data are then used to estimate economic costs of mercury exposure in these communities. Hair samples were collected from sites located in 15 countries. We used a linear dose-response relationship that previously identified a 0.18 IQ point decrement per part per million (ppm) increase in hair mercury, and modeled a base case scenario assuming a reference level of 1 ppm, and a second scenario assuming no reference level. We then estimated the corresponding increases in intellectual disability and lost Disability-Adjusted Life Years (DALY). A total of 236 participants provided hair samples for analysis, with an estimated population at risk of mercury exposure near the 15 sites of 11,302,582. Average mercury levels were in the range of 0.48 ppm-4.60 ppm, and 61% of all participants had hair mercury concentrations greater than 1 ppm, the level that approximately corresponds to the USA EPA reference dose. An additional 1310 cases of intellectual disability attributable to mercury exposure were identified annually (4110 assuming no reference level), resulting in 16,501 lost DALYs (51,809 assuming no reference level). A total of $77.4 million in lost economic productivity was estimated assuming a 1 ppm reference level and $130 million if no reference level was used. We conclude that significant mercury exposures occur in developing and transition country communities near sources named in the Minamata Convention, and our estimates suggest that a large economic burden could be avoided by timely implementation of measures to prevent mercury exposures. Copyright © 2016 Elsevier Ltd. All rights reserved.

Developing Tools to Counteract and Prevent Suicide Bomber Incidents: A Case Study in Value Sensitive Design.

PubMed

Royakkers, Lambèr; Steen, Marc

2017-08-01

Developers and designers make all sorts of moral decisions throughout an innovation project. In this article, we describe how teams of developers and designers engaged with ethics in the early phases of innovation based on case studies in the SUBCOP project (SUBCOP stands for 'SUicide Bomber COunteraction and Prevention'). For that purpose, Value Sensitive Design (VSD) will be used as a reference. Specifically, we focus on the following two research questions: How can researchers/developers learn about users' perspectives and values during the innovation process? and How can researchers/developers take into account these values, and related design criteria, in their decision-making during the innovation process? Based on a case study of several innovation processes in this project, we conclude the researchers/developers involved are able to do something similar to VSD (without them knowing about VSD or calling it 'VSD'), supported by relatively simple exercises in the project, e.g., meetings with potential end-users and discussions with members of the Ethical Advisory Board of the project. Furthermore, we also found-possibly somewhat counterintuitively-that a commercial, with its focus on understanding and satisfying customers' needs, can promote VSD.

Frequency of Unnecessarily Biopsies among Patients with Suspicion of Prostate Cancer in Syrian Men.

PubMed

Bachour, Dala-Maria; Chahin, Emil; Al-Fahoum, Sahar

2015-01-01

The prevalence of prostate cancer is considered high in many countries, and screening tests are very important in order to detect prostate cancer in its early stages; however false positivity with these screening tests means that a lot of patients undergo unnecessary biopsy, which is an invasive procedure, for the confirmatory test. The purpose of this study was to estimate the frequency of unnecessary biopsy cases in patients referred for prostate biopsy in one of the most important and overload cancer centers in Syria. Retrospective data for a period of four years between January 2009 and December 2012 were collected in Al- Bayrouni University Medical hospital in Damascus, Syria. The patients from whom data were collected were referred to our histopathological department because of elevated prostate specific antigen (PSA) serum or an abnormal digital rectal examination (DRE). All patients underwent prostatic TRUS-guided biopsies. Diagnosis of prostate cancer (PCa) or benign prostatic hyperplasia (BPH) was based on histopathological examination and prostate cancers cases were graded and scored according to the Gleason score system. For the 406 patients referred to biopsy, the mean±SD age was 58.4 ±23.3 years. The mean ± SD PSA level was 49.2±21.5 ng/ ml. Of the total we found 237 patients diagnosed with PCa (58. 4%), 166 patients with BPH (40.9%) and 3 cases were unable to be diagnosed (0.7%) because of biopsy collection errors. Our study shows that a high percentage of patients are undergoing unnecessary biopsy, which suggests that the performed screening tests had a high level of false positive and may need re-evaluation.

Validation of asthma recording in electronic health records: a systematic review

PubMed Central

Nissen, Francis; Quint, Jennifer K; Wilkinson, Samantha; Mullerova, Hana; Smeeth, Liam; Douglas, Ian J

2017-01-01

Objective To describe the methods used to validate asthma diagnoses in electronic health records and summarize the results of the validation studies. Background Electronic health records are increasingly being used for research on asthma to inform health services and health policy. Validation of the recording of asthma diagnoses in electronic health records is essential to use these databases for credible epidemiological asthma research. Methods We searched EMBASE and MEDLINE databases for studies that validated asthma diagnoses detected in electronic health records up to October 2016. Two reviewers independently assessed the full text against the predetermined inclusion criteria. Key data including author, year, data source, case definitions, reference standard, and validation statistics (including sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were summarized in two tables. Results Thirteen studies met the inclusion criteria. Most studies demonstrated a high validity using at least one case definition (PPV >80%). Ten studies used a manual validation as the reference standard; each had at least one case definition with a PPV of at least 63%, up to 100%. We also found two studies using a second independent database to validate asthma diagnoses. The PPVs of the best performing case definitions ranged from 46% to 58%. We found one study which used a questionnaire as the reference standard to validate a database case definition; the PPV of the case definition algorithm in this study was 89%. Conclusion Attaining high PPVs (>80%) is possible using each of the discussed validation methods. Identifying asthma cases in electronic health records is possible with high sensitivity, specificity or PPV, by combining multiple data sources, or by focusing on specific test measures. Studies testing a range of case definitions show wide variation in the validity of each definition, suggesting this may be important for obtaining asthma definitions with optimal validity. PMID:29238227

Leveraging tuberculosis case relative locations to enhance case detection and linkage to care in Swaziland.

PubMed

Brunetti, Marie; Rajasekharan, Sathyanath; Ustero, Piluca; Ngo, Katherine; Sikhondze, Welile; Mzileni, Buli; Mandalakas, Anna; Kay, Alexander W

2018-01-01

In Swaziland, as in many high HIV/TB burden settings, there is not information available regarding the household location of TB cases for identifying areas of increased TB incidence, limiting the development of targeted interventions. Data from "Butimba", a TB REACH active case finding project, was re-analyzed to provide insight into the location of TB cases surrounding Mbabane, Swaziland. The project aimed to identify geographical areas with high TB burdens to inform active case finding efforts. Butimba implemented household contact tracing; obtaining landmark based, informal directions, to index case homes, defined here as relative locations. The relative locations were matched to census enumeration areas (known location reference areas) using the Microsoft Excel Fuzzy Lookup function. Of 403 relative locations, an enumeration area reference was detected in 388 (96%). TB cases in each census enumeration area and the active case finders in each Tinkhundla, a local governmental region, were mapped using the geographic information system, QGIS 2.16. Urban Tinkhundla predictably accounted for most cases; however, after adjusting for population, the highest density of cases was found in rural Tinkhundla. There was no correlation between the number of active case finders currently assigned to the 7 Tinkhundla surrounding Mbabane and the total number of TB cases (Spearman rho = -0.57, p  = 0.17) or the population adjusted TB cases (Spearman rho = 0.14, p  = 0.75) per Tinkhundla. Reducing TB incidence in high-burden settings demands novel analytic approaches to study TB case locations. We demonstrated the feasibility of linking relative locations to more precise geographical areas, enabling data-driven guidance for National Tuberculosis Programs' resource allocation. In collaboration with the Swazi National Tuberculosis Control Program, this analysis highlighted opportunities to better align the active case finding national strategy with the TB disease burden.

Assessment of the incidence of GDV following splenectomy in dogs.

PubMed

Goldhammer, M A; Haining, H; Milne, E M; Shaw, D J; Yool, D A

2010-01-01

To establish if splenectomy increases the incidence of gastric dilatation and volvulus (GDV) in dogs. Two case-series studies of cases and controls were performed. Records of dogs that had undergone splenectomy (37 cases) were compared with records of dogs that had undergone other abdominal surgery (43 cases). Records of dogs that presented for non-elective gastropexy (33 cases) were compared with records of dogs presented to the hospital for unrelated reasons (39 cases). Survival following splenectomy and development of GDV in the first 12 months following surgery were retrieved from the clinical records and by questionnaire-based canvassing of the referring clinician. The incidence of GDV following splenectomy was established and the association between a current episode of GDV and previous splenectomy was assessed. There was no evidence that splenectomy was associated with an increased incidence of subsequent GDV (P=0.469). No association between a current episode of GDV and previous splenectomy was found. Splenectomy is not associated with an increase in the incidence of GDV.

Scientifically Based Research and Peer-Reviewed Research under the IDEA: The Legal Definitions, Applications, and Implications

ERIC Educational Resources Information Center

Zirkel, Perry A.; Rose, Tessie

2009-01-01

A systematic analysis of the references to "scientifically based research" (SBR) and closely related terms, such as "peer-reviewed research" (PRR), in the Individuals with Disabilities Education Act (IDEA) legislation, regulations, commentary, and case law reveal that SBR and its primary variants apply largely to state support…

A simple method for HPLC retention time prediction: linear calibration using two reference substances.

PubMed

Sun, Lei; Jin, Hong-Yu; Tian, Run-Tao; Wang, Ming-Juan; Liu, Li-Na; Ye, Liu-Ping; Zuo, Tian-Tian; Ma, Shuang-Cheng

2017-01-01

Analysis of related substances in pharmaceutical chemicals and multi-components in traditional Chinese medicines needs bulk of reference substances to identify the chromatographic peaks accurately. But the reference substances are costly. Thus, the relative retention (RR) method has been widely adopted in pharmacopoeias and literatures for characterizing HPLC behaviors of those reference substances unavailable. The problem is it is difficult to reproduce the RR on different columns due to the error between measured retention time (t R ) and predicted t R in some cases. Therefore, it is useful to develop an alternative and simple method for prediction of t R accurately. In the present study, based on the thermodynamic theory of HPLC, a method named linear calibration using two reference substances (LCTRS) was proposed. The method includes three steps, procedure of two points prediction, procedure of validation by multiple points regression and sequential matching. The t R of compounds on a HPLC column can be calculated by standard retention time and linear relationship. The method was validated in two medicines on 30 columns. It was demonstrated that, LCTRS method is simple, but more accurate and more robust on different HPLC columns than RR method. Hence quality standards using LCTRS method are easy to reproduce in different laboratories with lower cost of reference substances.

Bartonella, a Common Cause of Endocarditis: a Report on 106 Cases and Review

PubMed Central

Edouard, Sophie; Nabet, Cecile; Lepidi, Hubert; Fournier, Pierre-Edouard

2014-01-01

Bartonella spp. are fastidious bacteria that cause blood culture-negative endocarditis and have been increasingly reported. In this study, we included all patients retrospectively and prospectively diagnosed with Bartonella endocarditis in our French reference center between 2005 and 2013. Our diagnosis was based on the modified Duke criteria and microbiological findings, including serological and PCR results. To review the published literature, we searched all human Bartonella endocarditis cases published in the PubMed database between January 2005 and October 2013. We report here a large series of 106 cases, which include 59 cases that had not previously been reported or mentioned. Indirect immunofluorescence assays, Western blotting, and real-time PCR from total blood, serum, and valve tissue exhibited sensitivities of 58%, 100%, 33%, 36%, and 91%, respectively. The number of cases reported in the literature between 2005 and 2013 increased to reach a cumulative number of 196 cases. The number of cases reported in the literature by other centers is increasing more rapidly than that reported by our French reference center (P < 10−2). Currently, there is a lack of criteria for the diagnosis of Bartonella endocarditis. We suggest that a positive PCR result from a cardiac valve or blood specimen, an IgG titer of ≥800 using an immunofluorescence assay, or a positive Western blot assay be considered major Duke criteria for Bartonella endocarditis. There is no real increase in the incidence of these infections but rather a better understanding and interest in the disease resulting from the improvement of diagnostic tools. PMID:25540398

Child Sexual Abuse: A Case Study in Community Collaboration.

ERIC Educational Resources Information Center

Faller, Kathleen Coulborn; Henry, James

2000-01-01

A study investigated the effectiveness of a collaborative approach to the case management of child sexual abuse. Data from 323 criminal court files found a sex offense confession rate of 64 percent and plea rate of 70 percent. Fifteen cases went to trial and in six the offender was convicted. (Contains references.) (Author/CR)

A Survey of Telephone Inquiries: Case Study and Operational Impact in an Academic Library Reference Department.

ERIC Educational Resources Information Center

Allen, Frank R.; Smith, Rita H.

1993-01-01

Describes a survey that was conducted at the University of Tennessee at Knoxville library to count and categorize the types of questions coming into the reference department from telephone calls. Informational and directional calls are examined, implications for staffing are considered, and queuing theory is applied. (seven references) (LRW)

Evaluation of the Diagnostic Utility of the Traditional and Revised WHO Dengue Case Definitions

PubMed Central

Gutiérrez, Gamaliel; Gresh, Lionel; Pérez, María Ángeles; Elizondo, Douglas; Avilés, William; Kuan, Guillermina; Balmaseda, Ángel; Harris, Eva

2013-01-01

Dengue, a mosquito-borne viral illness, is a major public health problem worldwide, and its incidence continues to increase. In 2009, the World Health Organization published guidelines that included a revision of the dengue case definition. Compared to the traditional definition, the revised case definition relies more on signs than on symptoms, making it more applicable to young children. We evaluated the diagnostic utility of both case definitions in two studies of pediatric dengue in Managua, Nicaragua. In a community-based cohort study, we included data from 3,407 suspected dengue cases, of which 476 were laboratory-confirmed. In the second study, we collected information from 1,160 participants recruited at the national pediatric reference hospital (723 laboratory-confirmed). In the cohort study, the traditional definition had 89.3% sensitivity and 43.1% specificity, while the revised definition yielded similar sensitivity (86.6%) and higher specificity (55.2%, p<0.001). In the hospital study, the traditional case definition yielded 96.7% sensitivity and 22.0% specificity, whereas the revised case definition had higher sensitivity (99.3%, p<0.001) but lower specificity (8.5%, p<0.001). We then evaluated the performance of two diagnostic models based on the signs/symptoms included in each definition by analyzing the effect of increasing numbers of signs/symptoms on the sensitivity and specificity of case capture. Receiver operating characteristic analysis showed a slightly better performance for the revised model in both studies. Interestingly, despite containing less symptoms that cannot be readily expressed by children aged less than 4 years, the revised definition did not perform better in this age group. Overall, our results indicate that both case definitions have similar capacity to diagnose dengue. Owing to their high sensitivity and low specificity, they should be primarily used for screening purposes. However, in a primary care setting, neither of the case definitions performed well as a screening test in younger children. PMID:23991237

Analysis of Restricted Natural Gas Supply Cases

EIA Publications

2004-01-01

The four cases examined in this study have progressively greater impacts on overall natural gas consumption, prices, and supply. Compared to the Annual Energy Outlook 2004 reference case, the no Alaska pipeline case has the least impact; the low liquefied natural gas case has more impact; the low unconventional gas recovery case has even more impact; and the combined case has the most impact.

Control of the repeatability of high frequency multibeam echosounder backscatter by using natural reference areas

NASA Astrophysics Data System (ADS)

Roche, Marc; Degrendele, Koen; Vrignaud, Christophe; Loyer, Sophie; Le Bas, Tim; Augustin, Jean-Marie; Lurton, Xavier

2018-06-01

The increased use of backscatter measurements in time series for environmental monitoring necessitates the comparability of individual results. With the current lack of pre-calibrated multibeam echosounder systems for absolute backscatter measurement, a pragmatic solution is the use of natural reference areas for ensuring regular assessment of the backscatter measurement repeatability. This method mainly relies on the assumption of a sufficiently stable reference area regarding its backscatter signature. The aptitude of a natural area to provide a stable and uniform backscatter response must be carefully considered and demonstrated by a sufficiently long time-series of measurements. Furthermore, this approach requires a strict control of the acquisition and processing parameters. If all these conditions are met, stability check and relative calibration of a system are possible by comparison with the averaged backscatter values for the area. Based on a common multibeam echosounder and sampling campaign completed by available bathymetric and backscatter time series, the suitability as a backscatter reference area of three different candidates was evaluated. Two among them, Carré Renard and Kwinte, prove to be excellent choices, while the third one, Western Solent, lacks sufficient data over time, but remains a valuable candidate. The case studies and the available backscatter data on these areas prove the applicability of this method. The expansion of the number of commonly used reference areas and the growth of the number of multibeam echosounder controlled thereon could greatly contribute to the further development of quantitative applications based on multibeam echosounder backscatter measurements.

Prostate carcinoma mimicking a sphenoid wing meningioma

PubMed Central

Bradley, Lucas H.; Burton, Matthew; Gokden, Murat; Serletis, Demitre

2015-01-01

Introduction We report here on a rare case of a large, lateral sphenoid wing tumor with radiographic and intraoperative findings highly suggestive of meningioma, yet pathology was in fact consistent with metastatic prostate adenocarcinoma. Presentation of case An 81 year-old male presented with expressive dysphasia, right-sided weakness and headaches. Imaging revealed a heterogeneously-enhancing lesion based on the left lateral sphenoid wing. The presumed diagnosis was strongly in favor of meningioma, and the patient underwent complete resection of the dural-based lesion. Final pathology confirmed the unexpected finding of a metastatic prostate adenocarcinoma. Although he tolerated surgery well, the patient was subsequently referred for palliative therapy given findings of widespread systemic disease. Discussion Intracranial metastases may involve the dura, at times presenting with rare radiographic features highly suggestive for meningioma, as in our case here. This makes differentiation, at least based on imaging, a challenge. Elderly patients presenting with neurological deficits secondary to a newly-diagnosed, dural-based lesion should thus be considered for metastasis, prompting additional imaging studies (including body CT, MRI or PET) to rule out a primary lesion elsewhere. In some cases, this may affect the overall decision to proceed with surgical resection, or alternatively, to proceed directly to palliative therapy (the latter decision made in the context of widespread metastatic disease). Conclusion We conclude that dural-based metastatic lesions may mimic meningiomas, warranting thorough pre-operative work-up to exclude the possibility of metastasis. In certain cases, identification of widespread disease might preclude surgery and favor palliation, instead. PMID:26318129

A quasiparticle-based multi-reference coupled-cluster method.

PubMed

Rolik, Zoltán; Kállay, Mihály

2014-10-07

The purpose of this paper is to introduce a quasiparticle-based multi-reference coupled-cluster (MRCC) approach. The quasiparticles are introduced via a unitary transformation which allows us to represent a complete active space reference function and other elements of an orthonormal multi-reference (MR) basis in a determinant-like form. The quasiparticle creation and annihilation operators satisfy the fermion anti-commutation relations. On the basis of these quasiparticles, a generalization of the normal-ordered operator products for the MR case can be introduced as an alternative to the approach of Mukherjee and Kutzelnigg [Recent Prog. Many-Body Theor. 4, 127 (1995); Mukherjee and Kutzelnigg, J. Chem. Phys. 107, 432 (1997)]. Based on the new normal ordering any quasiparticle-based theory can be formulated using the well-known diagram techniques. Beyond the general quasiparticle framework we also present a possible realization of the unitary transformation. The suggested transformation has an exponential form where the parameters, holding exclusively active indices, are defined in a form similar to the wave operator of the unitary coupled-cluster approach. The definition of our quasiparticle-based MRCC approach strictly follows the form of the single-reference coupled-cluster method and retains several of its beneficial properties. Test results for small systems are presented using a pilot implementation of the new approach and compared to those obtained by other MR methods.

Idiopathic Supraglottic Stenosis Refractory to Multiple Interventions Improved With Serial Office-based Steroid Injections.

PubMed

Hoffman, Matthew R; Mai, Johnny P; Dailey, Seth H

2017-10-30

The objective of this study was to describe a patient with idiopathic supraglottic stenosis who experienced persistent disease despite multiple office-based and operative interventions, whose disease is now better controlled with scheduled serial office-based steroid injections. This is a case report and literature review. A 42-year-old female was referred for worsening supraglottic stenosis despite systemic steroids. She underwent awake tracheotomy. A thorough historical, histologic, and laboratory workup did not reveal an etiology to her stenosis. She later underwent endoscopic partial laryngectomy and was able to be decannulated. She underwent a second endoscopic partial laryngectomy two years later for worsening disease and then was managed over the next seven years with intermittent systemic steroids. Over the last year, she has undergone eight office-based steroid injections with improvement in her degree of stenosis and symptom burden. There are only four prior reported cases of idiopathic supraglottic stenosis, none of which has been managed with serial office-based steroid injections. This case report adds to the small body of literature on the management of this rare disease and proposes a new office-based treatment pathway that may help induce regression of stenosis. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Industrial Adoption of Model-Based Systems Engineering: Challenges and Strategies

NASA Astrophysics Data System (ADS)

Maheshwari, Apoorv

As design teams are becoming more globally integrated, one of the biggest challenges is to efficiently communicate across the team. The increasing complexity and multi-disciplinary nature of the products are also making it difficult to keep track of all the information generated during the design process by these global team members. System engineers have identified Model-based Systems Engineering (MBSE) as a possible solution where the emphasis is placed on the application of visual modeling methods and best practices to systems engineering (SE) activities right from the beginning of the conceptual design phases through to the end of the product lifecycle. Despite several advantages, there are multiple challenges restricting the adoption of MBSE by industry. We mainly consider the following two challenges: a) Industry perceives MBSE just as a diagramming tool and does not see too much value in MBSE; b) Industrial adopters are skeptical if the products developed using MBSE approach will be accepted by the regulatory bodies. To provide counter evidence to the former challenge, we developed a generic framework for translation from an MBSE tool (Systems Modeling Language, SysML) to an analysis tool (Agent-Based Modeling, ABM). The translation is demonstrated using a simplified air traffic management problem and provides an example of a potential quite significant value: the ability to use MBSE representations directly in an analysis setting. For the latter challenge, we are developing a reference model that uses SysML to represent a generic infusion pump and SE process for planning, developing, and obtaining regulatory approval of a medical device. This reference model demonstrates how regulatory requirements can be captured effectively through model-based representations. We will present another case study at the end where we will apply the knowledge gained from both case studies to a UAV design problem.

Multiple scattering corrections to the Beer-Lambert law. 2: Detector with a variable field of view.

PubMed

Zardecki, A; Tam, W G

1982-07-01

The multiple scattering corrections to the Beer-Lambert law in the case of a detector with a variable field of view are analyzed. We introduce transmission functions relating the received radiant power to reference power levels relevant to two different experimental situations. In the first case, the transmission function relates the received power to a reference power level appropriate to a nonattenuating medium. In the second case, the reference power level is established by bringing the receiver to the close-up position with respect to the source. To examine the effect of the variation of the detector field of view the behavior of the gain factor is studied. Numerical results modeling the laser beam propagation in fog, cloud, and rain are presented.

The skeletal trauma resulting from a fatal B.A.S.E jump: A case study showing the impact of landing feet-first under extreme vertical deceleration.

PubMed

Rowbotham, Samantha K; Blau, Soren; Hislop-Jambrich, Jacqueline

2018-05-01

The term 'B.A.S.E jump' refers to jumping from a building, antenna, span (i.e., bridge) or earth (i.e., cliff) structure, and parachuting to the ground. There are numerous hazards associated with B.A.S.E jumps which often result in injury and, occasionally, fatality. This case report details the skeletal trauma resulting from a fatal B.A.S.E jump in Australia. In this case, the jumper impacted the ground from a fall of 439m in a feet-first landing position, as a result of a partially deployed parachute, under extreme vertical deceleration. Skeletal trauma was analyzed using full-body post mortem computed tomography (PMCT) and contextual information related to the circumstances of the jump as reported by the Coroner. Trauma to 61 skeletal elements indicates the primary impact was to the feet (i.e., feet-first landing), followed by an anterior impact to the body (i.e., fall forwards). Details of the individual fracture morphologies indicate the various forces and biomechanics involved in this fall event. This case presents the types of fractures that result from a B.A.S.E jump, and highlights the value of using PMCT and coronial data as tools to augment skeletal trauma interpretations. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Initiation of non-invasive ventilation in amyotrophic lateral sclerosis and clinical practice guidelines: Single-centre, retrospective, descriptive study in a national reference centre.

PubMed

Georges, Marjolaine; Golmard, Jean-Louis; Llontop, Claudia; Shoukri, Amr; Salachas, François; Similowski, Thomas; Morelot-Panzini, Capucine; Gonzalez-Bermejo, Jésus

2017-02-01

In amyotrophic lateral sclerosis (ALS), respiratory muscle weakness leads to respiratory failure. Non-invasive ventilation (NIV) maintains adequate ventilation in ALS patients. NIV alleviates symptoms and improves survival. In 2006, French guidelines established criteria for NIV initiation based on limited evidence. Their impact on clinical practice remains unknown. Our objective was to describe NIV initiation practices of the main French ALS tertiary referral centre with respect to guidelines. In this retrospective descriptive study, 624 patients followed in a single national reference centre began NIV between 2005 and 2013. We analysed criteria used to initiate NIV, including symptoms, PaCO 2 , forced vital capacity, maximal inspiratory pressures and time spent with SpO 2 <90% at night. At NIV initiation, 90% of patients were symptomatic. Median PaCO 2 was 48 mmHg. The main criterion to initiate NIV was 'symptoms' followed by 'hypercapnia' in 42% and 34% of cases, respectively. NIV was initiated on functional parameters in only 5% of cases. Guidelines were followed in 81% of cases. In conclusion, despite compliance with French guidelines, the majority of patients are treated at the stage of symptomatic daytime hypoventilation, which suggests that NIV is initiated late in the course of ALS. Whether this practice could be improved by changing guidelines or increasing respiratory-dedicated resources remains to be determined.

Birth order and sibship size: evaluation of the role of selection bias in a case-control study of non-Hodgkin's lymphoma.

PubMed

Mensah, F K; Willett, E V; Simpson, J; Smith, A G; Roman, E

2007-09-15

Substantial heterogeneity has been observed among case-control studies investigating associations between non-Hodgkin's lymphoma and familial characteristics, such as birth order and sibship size. The potential role of selection bias in explaining such heterogeneity is considered within this study. Selection bias according to familial characteristics and socioeconomic status is investigated within a United Kingdom-based case-control study of non-Hodgkin's lymphoma diagnosed during 1998-2001. Reported distributions of birth order and maternal age are each compared with expected reference distributions derived using national birth statistics from the United Kingdom. A method is detailed in which yearly data are used to derive expected distributions, taking account of variability in birth statistics over time. Census data are used to reweight both the case and control study populations such that they are comparable with the general population with regard to socioeconomic status. The authors found little support for an association between non-Hodgkin's lymphoma and birth order or family size and little evidence for an influence of selection bias. However, the findings suggest that between-study heterogeneity could be explained by selection biases that influence the demographic characteristics of participants.

Subgroup Benchmark Calculations for the Intra-Pellet Nonuniform Temperature Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Kang Seog; Jung, Yeon Sang; Liu, Yuxuan

A benchmark suite has been developed by Seoul National University (SNU) for intrapellet nonuniform temperature distribution cases based on the practical temperature profiles according to the thermal power levels. Though a new subgroup capability for nonuniform temperature distribution was implemented in MPACT, no validation calculation has been performed for the new capability. This study focuses on bench-marking the new capability through a code-to-code comparison. Two continuous-energy Monte Carlo codes, McCARD and CE-KENO, are engaged in obtaining reference solutions, and the MPACT results are compared to the SNU nTRACER using a similar cross section library and subgroup method to obtain self-shieldedmore » cross sections.« less

Development and Evaluation of Reference Standards for Image-based Telemedicine Diagnosis and Clinical Research Studies in Ophthalmology

PubMed Central

Ryan, Michael C.; Ostmo, Susan; Jonas, Karyn; Berrocal, Audina; Drenser, Kimberly; Horowitz, Jason; Lee, Thomas C.; Simmons, Charles; Martinez-Castellanos, Maria-Ana; Chan, R.V. Paul; Chiang, Michael F.

2014-01-01

Information systems managing image-based data for telemedicine or clinical research applications require a reference standard representing the correct diagnosis. Accurate reference standards are difficult to establish because of imperfect agreement among physicians, and discrepancies between clinical vs. image-based diagnosis. This study is designed to describe the development and evaluation of reference standards for image-based diagnosis, which combine diagnostic impressions of multiple image readers with the actual clinical diagnoses. We show that agreement between image reading and clinical examinations was imperfect (689 [32%] discrepancies in 2148 image readings), as was inter-reader agreement (kappa 0.490-0.652). This was improved by establishing an image-based reference standard defined as the majority diagnosis given by three readers (13% discrepancies with image readers). It was further improved by establishing an overall reference standard that incorporated the clinical diagnosis (10% discrepancies with image readers). These principles of establishing reference standards may be applied to improve robustness of real-world systems supporting image-based diagnosis. PMID:25954463

Human biomonitoring reference values for metals and trace elements in blood and urine derived from the Canadian Health Measures Survey 2007-2013.

PubMed

Saravanabhavan, Gurusankar; Werry, Kate; Walker, Mike; Haines, Douglas; Malowany, Morie; Khoury, Cheryl

2017-03-01

Human biomonitoring reference values are statistical estimates that indicate the upper margin of background exposure to a given chemical at a given time. Nationally representative human biomonitoring data on 176 chemicals, including several metals and trace elements, are available in Canada from 2007 to 2013 through the Canadian Health Measures Survey (CHMS). In this work, we used a systematic approach based on the reference interval concept proposed by the International Federation of Clinical Chemistry and Laboratory Medicine and the International Union of Pure and Applied Chemistry to derive reference values (RV 95 s) for metals and trace elements. These RV 95 s were derived for blood and urine matrices in the general Canadian population based on the latest biomonitoring data from the CHMS. Biomarkers were chosen based on specific selection criteria, including widespread detection in Canadians (≥66% detection rate). Reference populations were created for each biomarker by applying appropriate exclusion criteria. Age and sex were evaluated as possible partitioning criteria and separate RV 95 s were derived for the sub-populations in cases where partitioning was deemed necessary. The RV 95 s for metals and trace elements in blood ranged from 0.18μg/L for cadmium in young children aged 3-5 years to 7900μg/L for zinc in males aged 20-79 years. In the case of urinary biomarkers, the RV 95 s ranged from 0.17μg/L for antimony in the total population aged 3-79 years to 1400mg/L for fluoride in adults aged 20-79 years. These RV 95 s represent the first set of reference values for metals and trace elements in the general Canadian population. We compare the RV 95 s from other countries where available and discuss factors that could influence such comparisons. Copyright © 2016 The Authors. Published by Elsevier GmbH.. All rights reserved.

Simulations and parameterisation of shallow volcanic plumes of Piton de la Fournaise, Reunion Island, using Meso-NH version 4-9-3

NASA Astrophysics Data System (ADS)

Sivia, S. G.; Gheusi, F.; Mari, C.; Di Muro, A.

2015-05-01

In mesoscale models (resolution ~ 1 km) used for regional dispersion of pollution plumes the volcanic heat sources and emissions of gases and aerosols, as well as the induced atmospheric convective motions, are all sub-grid-scale processes (mostly true for weak effusive eruptions) which need to be parameterised. We propose a modified formulation of the EDMF scheme (eddy diffusivity/mass flux) proposed by Pergaud et al. (2009) which is based on a single sub-grid updraft model. It is used to represent volcano induced updrafts tested for a case study of the January 2010 summit eruption of Piton de la Fournaise (PdF) volcano. The validation of this modified formulation using a reference large eddy simulation (LES) focuses on the ability of the model to transport tracer concentrations up to 1-2 km above the ground in the lower troposphere as is the case of majority of PdF eruptions. The modelled volcanic plume agrees reasonably with the profiles of SO2 (sulfur dioxide) tracer concentrations and specific humidity found from the reference LES. Sensitivity tests performed for the modified formulation of the EDMF scheme emphasise the sensitivity of the parameterisation to ambient fresh air entrainment at the plume base.

Health Informatics Scientists' Perception About Big Data Technology.

PubMed

Minou, John; Routsis, Fotios; Gallos, Parisis; Mantas, John

2017-01-01

The aim of this paper is to present the perceptions of the Health Informatics Scientists about the Big Data Technology in Healthcare. An empirical study was conducted among 46 scientists to assess their knowledge about the Big Data Technology and their perceptions about using this technology in healthcare. Based on the study findings, 86.7% of the scientists had knowledge of Big data Technology. Furthermore, 59.1% of the scientists believed that Big Data Technology refers to structured data. Additionally, 100% of the population believed that Big Data Technology can be implemented in Healthcare. Finally, the majority does not know any cases of use of Big Data Technology in Greece while 57,8% of the them mentioned that they knew use cases of the Big Data Technology abroad.

Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients.

PubMed

Zhang, Chi; Ke, Weixia; Liu, Li; Gao, Yanhui; Yao, Zhenjiang; Ye, Xiaohua; Zhou, Shudong; Yang, Yi

2016-01-01

Lamivudine (LAM) plus adefovir (ADV) combination therapy is clinically efficacious for treating chronic hepatitis B (CHB) patients in China, but no pharmacoeconomic evaluations of this strategy are available. The aim of this study was to examine the cost-effectiveness of LAM plus ADV combination treatment compared with five other nucleos(t)ide analog monotherapies (LAM, ADV, telbivudine [TBV], entecavir [ETV], and tenofovir [TDF]). To simulate the lifetime (40-year time span) costs and quality-adjusted life-years (QALYs) for different therapy options, a Markov model that included five initial monotherapies and LAM plus ADV combination as an initial treatment was developed. Two kinds of rescue combination strategies (base-case: LAM + ADV then ETV + ADV; alternative: direct use of ETV + ADV) were considered separately for treating patients refractory to initial therapy. One-way and probabilistic sensitivity analyses were used to explore model uncertainties. In base-case analysis, ETV had the lowest lifetime cost and served as the reference therapy. Compared to the reference, LAM, ADV, and TBV had higher costs and lower efficacy, and were completely dominated by ETV. LAM plus ADV combination therapy or TDF was more efficacious than ETV, but also more expensive. Although the incremental cost-effectiveness ratios of combination therapy or TDF were both higher than the willingness-to-pay threshold of $20,466/QALY gained for the reference treatment, in an alternative scenario analysis LAM plus ADV combination therapy would be the preferable treatment option. ETV and LAM plus ADV combination therapy are both cost-effective strategies for treating Chinese CHB patients.

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective.

PubMed

Fathima, Mariam; Saini, Bandana; Foster, Juliet M; Armour, Carol L

2017-01-01

Case finding of patients at risk of COPD by community pharmacists could identify a substantial number of people with undiagnosed COPD, but little is known about the feasibility and effectiveness of pharmacy-based COPD case finding using microspirometry. The objective of this study was to assess the feasibility and effectiveness of COPD case-finding service provided by community pharmacists, utilizing a combination of risk assessment questionnaire and microspirometry. A 6-month service was conducted in 21 community pharmacies in Australia. Pharmacists trained in COPD case finding, including lung function test (LFT), invited their patients aged ≥35 years with a history of smoking and/or respiratory symptoms to participate. High-risk patients were identified via a COPD risk assessment questionnaire (Initial Screening Questionnaire [ISQ]) and underwent LFT. Pharmacists referred patients with a forced expiratory volume in 1 second (FEV 1 )/forced expiratory volume in 6 seconds (FEV 6 ) ratio <0.75 to their general practitioner (GP) for further assessment and diagnosis. In all, 91 of 167 (54%) patients had an ISQ score >3 indicating high COPD risk. Of the 157 patients who were able to complete LFT, 61 (39%) had an FEV 1 /FEV 6 ratio of <0.75 and were referred to their GP. Patients with high ISQ symptoms scores (>3) were at a significantly higher risk of an FEV 1 /FEV 6 ratio of <0.75, compared to patients with fewer COPD symptoms. A total of 15 (10%) patients were diagnosed with COPD by their GP. Another eight (5%) patients were diagnosed with other medical conditions and 87% of these were initiated on treatment. Although only half of all screened patients lived in regional areas, 93% of those diagnosed with COPD were from regional areas. A brief community pharmacy-based COPD case-finding service utilizing the ISQ, LFT and GP referral is feasible and may lead to identification and diagnosis of a substantial number of people with COPD. This might be an important strategy for reducing the burden of COPD, particularly for those living in rural locations.

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

PubMed Central

Fathima, Mariam; Saini, Bandana; Foster, Juliet M; Armour, Carol L

2017-01-01

Background and objective Case finding of patients at risk of COPD by community pharmacists could identify a substantial number of people with undiagnosed COPD, but little is known about the feasibility and effectiveness of pharmacy-based COPD case finding using microspirometry. The objective of this study was to assess the feasibility and effectiveness of COPD case-finding service provided by community pharmacists, utilizing a combination of risk assessment questionnaire and microspirometry. Methods A 6-month service was conducted in 21 community pharmacies in Australia. Pharmacists trained in COPD case finding, including lung function test (LFT), invited their patients aged ≥35 years with a history of smoking and/or respiratory symptoms to participate. High-risk patients were identified via a COPD risk assessment questionnaire (Initial Screening Questionnaire [ISQ]) and underwent LFT. Pharmacists referred patients with a forced expiratory volume in 1 second (FEV1)/forced expiratory volume in 6 seconds (FEV6) ratio <0.75 to their general practitioner (GP) for further assessment and diagnosis. Results In all, 91 of 167 (54%) patients had an ISQ score >3 indicating high COPD risk. Of the 157 patients who were able to complete LFT, 61 (39%) had an FEV1/FEV6 ratio of <0.75 and were referred to their GP. Patients with high ISQ symptoms scores (>3) were at a significantly higher risk of an FEV1/FEV6 ratio of <0.75, compared to patients with fewer COPD symptoms. A total of 15 (10%) patients were diagnosed with COPD by their GP. Another eight (5%) patients were diagnosed with other medical conditions and 87% of these were initiated on treatment. Although only half of all screened patients lived in regional areas, 93% of those diagnosed with COPD were from regional areas. Conclusion A brief community pharmacy-based COPD case-finding service utilizing the ISQ, LFT and GP referral is feasible and may lead to identification and diagnosis of a substantial number of people with COPD. This might be an important strategy for reducing the burden of COPD, particularly for those living in rural locations. PMID:29075108

Unified Bayesian Estimator of EEG Reference at Infinity: rREST (Regularized Reference Electrode Standardization Technique).

PubMed

Hu, Shiang; Yao, Dezhong; Valdes-Sosa, Pedro A

2018-01-01

The choice of reference for the electroencephalogram (EEG) is a long-lasting unsolved issue resulting in inconsistent usages and endless debates. Currently, both the average reference (AR) and the reference electrode standardization technique (REST) are two primary, apparently irreconcilable contenders. We propose a theoretical framework to resolve this reference issue by formulating both (a) estimation of potentials at infinity, and (b) determination of the reference, as a unified Bayesian linear inverse problem, which can be solved by maximum a posterior estimation. We find that AR and REST are very particular cases of this unified framework: AR results from biophysically non-informative prior; while REST utilizes the prior based on the EEG generative model. To allow for simultaneous denoising and reference estimation, we develop the regularized versions of AR and REST, named rAR and rREST, respectively. Both depend on a regularization parameter that is the noise to signal variance ratio. Traditional and new estimators are evaluated with this framework, by both simulations and analysis of real resting EEGs. Toward this end, we leverage the MRI and EEG data from 89 subjects which participated in the Cuban Human Brain Mapping Project. Generated artificial EEGs-with a known ground truth, show that relative error in estimating the EEG potentials at infinity is lowest for rREST. It also reveals that realistic volume conductor models improve the performances of REST and rREST. Importantly, for practical applications, it is shown that an average lead field gives the results comparable to the individual lead field. Finally, it is shown that the selection of the regularization parameter with Generalized Cross-Validation (GCV) is close to the "oracle" choice based on the ground truth. When evaluated with the real 89 resting state EEGs, rREST consistently yields the lowest GCV. This study provides a novel perspective to the EEG reference problem by means of a unified inverse solution framework. It may allow additional principled theoretical formulations and numerical evaluation of performance.

Multi-point Adjoint-Based Design of Tilt-Rotors in a Noninertial Reference Frame

NASA Technical Reports Server (NTRS)

Jones, William T.; Nielsen, Eric J.; Lee-Rausch, Elizabeth M.; Acree, Cecil W.

2014-01-01

Optimization of tilt-rotor systems requires the consideration of performance at multiple design points. In the current study, an adjoint-based optimization of a tilt-rotor blade is considered. The optimization seeks to simultaneously maximize the rotorcraft figure of merit in hover and the propulsive efficiency in airplane-mode for a tilt-rotor system. The design is subject to minimum thrust constraints imposed at each design point. The rotor flowfields at each design point are cast as steady-state problems in a noninertial reference frame. Geometric design variables used in the study to control blade shape include: thickness, camber, twist, and taper represented by as many as 123 separate design variables. Performance weighting of each operational mode is considered in the formulation of the composite objective function, and a build up of increasing geometric degrees of freedom is used to isolate the impact of selected design variables. In all cases considered, the resulting designs successfully increase both the hover figure of merit and the airplane-mode propulsive efficiency for a rotor designed with classical techniques.

Generation of “Virtual” Control Groups for Single Arm Prostate Cancer Adjuvant Trials

PubMed Central

Koziol, James A.; Chen, Xin; Xia, Xiao-Qin; Wang, Yipeng; Skarecky, Douglas; Sutton, Manuel; Sawyers, Anne; Ruckle, Herbert; Carpenter, Philip M.; Wang-Rodriguez, Jessica; Jiang, Jun; Deng, Mingsen; Pan, Cong; Zhu, Jian-guo; McLaren, Christine E.; Gurley, Michael J.; Lee, Chung; McClelland, Michael; Ahlering, Thomas; Kattan, Michael W.; Mercola, Dan

2014-01-01

It is difficult to construct a control group for trials of adjuvant therapy (Rx) of prostate cancer after radical prostatectomy (RP) due to ethical issues and patient acceptance. We utilized 8 curve-fitting models to estimate the time to 60%, 65%, … 95% chance of progression free survival (PFS) based on the data derived from Kattan post-RP nomogram. The 8 models were systematically applied to a training set of 153 post-RP cases without adjuvant Rx to develop 8 subsets of cases (reference case sets) whose observed PFS times were most accurately predicted by each model. To prepare a virtual control group for a single-arm adjuvant Rx trial, we first select the optimal model for the trial cases based on the minimum weighted Euclidean distance between the trial case set and the reference case set in terms of clinical features, and then compare the virtual PFS times calculated by the optimum model with the observed PFSs of the trial cases by the logrank test. The method was validated using an independent dataset of 155 post-RP patients without adjuvant Rx. We then applied the method to patients on a Phase II trial of adjuvant chemo-hormonal Rx post RP, which indicated that the adjuvant Rx is highly effective in prolonging PFS after RP in patients at high risk for prostate cancer recurrence. The method can accurately generate control groups for single-arm, post-RP adjuvant Rx trials for prostate cancer, facilitating development of new therapeutic strategies. PMID:24465467

Generation of "virtual" control groups for single arm prostate cancer adjuvant trials.

PubMed

Jia, Zhenyu; Lilly, Michael B; Koziol, James A; Chen, Xin; Xia, Xiao-Qin; Wang, Yipeng; Skarecky, Douglas; Sutton, Manuel; Sawyers, Anne; Ruckle, Herbert; Carpenter, Philip M; Wang-Rodriguez, Jessica; Jiang, Jun; Deng, Mingsen; Pan, Cong; Zhu, Jian-Guo; McLaren, Christine E; Gurley, Michael J; Lee, Chung; McClelland, Michael; Ahlering, Thomas; Kattan, Michael W; Mercola, Dan

2014-01-01

It is difficult to construct a control group for trials of adjuvant therapy (Rx) of prostate cancer after radical prostatectomy (RP) due to ethical issues and patient acceptance. We utilized 8 curve-fitting models to estimate the time to 60%, 65%, … 95% chance of progression free survival (PFS) based on the data derived from Kattan post-RP nomogram. The 8 models were systematically applied to a training set of 153 post-RP cases without adjuvant Rx to develop 8 subsets of cases (reference case sets) whose observed PFS times were most accurately predicted by each model. To prepare a virtual control group for a single-arm adjuvant Rx trial, we first select the optimal model for the trial cases based on the minimum weighted Euclidean distance between the trial case set and the reference case set in terms of clinical features, and then compare the virtual PFS times calculated by the optimum model with the observed PFSs of the trial cases by the logrank test. The method was validated using an independent dataset of 155 post-RP patients without adjuvant Rx. We then applied the method to patients on a Phase II trial of adjuvant chemo-hormonal Rx post RP, which indicated that the adjuvant Rx is highly effective in prolonging PFS after RP in patients at high risk for prostate cancer recurrence. The method can accurately generate control groups for single-arm, post-RP adjuvant Rx trials for prostate cancer, facilitating development of new therapeutic strategies.

The impact of anthropometric patient-phantom matching on organ dose: A hybrid phantom study for fluoroscopy guided interventions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, Perry B.; Geyer, Amy; Borrego, David

Purpose: To investigate the benefits and limitations of patient-phantom matching for determining organ dose during fluoroscopy guided interventions. Methods: In this study, 27 CT datasets representing patients of different sizes and genders were contoured and converted into patient-specific computational models. Each model was matched, based on height and weight, to computational phantoms selected from the UF hybrid patient-dependent series. In order to investigate the influence of phantom type on patient organ dose, Monte Carlo methods were used to simulate two cardiac projections (PA/left lateral) and two abdominal projections (RAO/LPO). Organ dose conversion coefficients were then calculated for each patient-specific andmore » patient-dependent phantom and also for a reference stylized and reference hybrid phantom. The coefficients were subsequently analyzed for any correlation between patient-specificity and the accuracy of the dose estimate. Accuracy was quantified by calculating an absolute percent difference using the patient-specific dose conversion coefficients as the reference. Results: Patient-phantom matching was shown most beneficial for estimating the dose to heavy patients. In these cases, the improvement over using a reference stylized phantom ranged from approximately 50% to 120% for abdominal projections and for a reference hybrid phantom from 20% to 60% for all projections. For lighter individuals, patient-phantom matching was clearly superior to using a reference stylized phantom, but not significantly better than using a reference hybrid phantom for certain fields and projections. Conclusions: The results indicate two sources of error when patients are matched with phantoms: Anatomical error, which is inherent due to differences in organ size and location, and error attributed to differences in the total soft tissue attenuation. For small patients, differences in soft tissue attenuation are minimal and are exceeded by inherent anatomical differences. For large patients, difference in soft tissue attenuation can be large. In these cases, patient-phantom matching proves most effective as differences in soft tissue attenuation are mitigated. With increasing obesity rates, overweight patients will continue to make up a growing fraction of all patients undergoing medical imaging. Thus, having phantoms that better represent this population represents a considerable improvement over previous methods. In response to this study, additional phantoms representing heavier weight percentiles will be added to the UFHADM and UFHADF patient-dependent series.« less

Experience with biosimilar infliximab (CT-P13) in paediatric patients with inflammatory bowel diseases

PubMed Central

Sieczkowska, Joanna; Jarzębicka, Dorota; Meglicka, Monika; Oracz, Grzegorz; Kierkus, Jaroslaw

2016-01-01

Infliximab was the first monoclonal antibody used in the treatment of inflammatory bowel disease (IBD). Over several years, this antitumour necrosis factor (TNF) treatment proved its efficacy in both induction and maintenance therapy. In many cases this biological treatment stopped the progression of the disease, probably also decreasing morbidity and hospitalization rates, and improving patients’ comfort. When the patent on infliximab started to expire, the first biosimilar of a monoclonal antibody was introduced onto the pharmacological market. Biosimilar infliximab was studied in rheumatology and proved a high similarity to the reference drug. Based on extrapolation, biosimilars were approved to treat adult and paediatric IBD patients. Biosimilar infliximab, mainly because of its lower cost, has started to be in common use in Europe. The first studies have shown a similar efficacy and safety profile in comparison with reference drug. Biosimilar infliximab is raising hopes for improving the availability of this effective treatment. PMID:27582886

Comparison of reference doses (RfDs) developed for the protection of wildlife species in contrast to humans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Valoppi, L.; Carlisle, J.; Polisini, J.

1995-12-31

A component of both human health and ecological risk assessments is the evaluation of toxicity values. A comparison between the methodology for the development of Reference Doses (RfDs) to be protective of humans, and that developed for vertebrate wildlife species is presented. For all species, a chronic No Observable Adverse Effect Level (NOAEL) is developed by applying uncertainty factors (UFs) to literature-based toxicity values. Uncertainty factors are used to compensate for the length of exposure, sensitivity of endpoints, and cross-species extrapolations between the test species and the species being assessed. Differences between human and wildlife species could include the toxicologicalmore » endpoint, the critical study, and the magnitude of the cross-species extrapolation factor. Case studies for select chemicals are presented which contrast RfDs developed for humans and those developed for avian and mammalian wildlife.« less

Variability in CT lung-nodule quantification: Effects of dose reduction and reconstruction methods on density and texture based features.

PubMed

Lo, P; Young, S; Kim, H J; Brown, M S; McNitt-Gray, M F

2016-08-01

To investigate the effects of dose level and reconstruction method on density and texture based features computed from CT lung nodules. This study had two major components. In the first component, a uniform water phantom was scanned at three dose levels and images were reconstructed using four conventional filtered backprojection (FBP) and four iterative reconstruction (IR) methods for a total of 24 different combinations of acquisition and reconstruction conditions. In the second component, raw projection (sinogram) data were obtained for 33 lung nodules from patients scanned as a part of their clinical practice, where low dose acquisitions were simulated by adding noise to sinograms acquired at clinical dose levels (a total of four dose levels) and reconstructed using one FBP kernel and two IR kernels for a total of 12 conditions. For the water phantom, spherical regions of interest (ROIs) were created at multiple locations within the water phantom on one reference image obtained at a reference condition. For the lung nodule cases, the ROI of each nodule was contoured semiautomatically (with manual editing) from images obtained at a reference condition. All ROIs were applied to their corresponding images reconstructed at different conditions. For 17 of the nodule cases, repeat contours were performed to assess repeatability. Histogram (eight features) and gray level co-occurrence matrix (GLCM) based texture features (34 features) were computed for all ROIs. For the lung nodule cases, the reference condition was selected to be 100% of clinical dose with FBP reconstruction using the B45f kernel; feature values calculated from other conditions were compared to this reference condition. A measure was introduced, which the authors refer to as Q, to assess the stability of features across different conditions, which is defined as the ratio of reproducibility (across conditions) to repeatability (across repeat contours) of each feature. The water phantom results demonstrated substantial variability among feature values calculated across conditions, with the exception of histogram mean. Features calculated from lung nodules demonstrated similar results with histogram mean as the most robust feature (Q ≤ 1), having a mean and standard deviation Q of 0.37 and 0.22, respectively. Surprisingly, histogram standard deviation and variance features were also quite robust. Some GLCM features were also quite robust across conditions, namely, diff. variance, sum variance, sum average, variance, and mean. Except for histogram mean, all features have a Q of larger than one in at least one of the 3% dose level conditions. As expected, the histogram mean is the most robust feature in their study. The effects of acquisition and reconstruction conditions on GLCM features vary widely, though trending toward features involving summation of product between intensities and probabilities being more robust, barring a few exceptions. Overall, care should be taken into account for variation in density and texture features if a variety of dose and reconstruction conditions are used for the quantification of lung nodules in CT, otherwise changes in quantification results may be more reflective of changes due to acquisition and reconstruction conditions than in the nodule itself.

Developing patient reference groups within general practice: a mixed-methods study.

PubMed

Smiddy, Jane; Reay, Joanne; Peckham, Stephen; Williams, Lorraine; Wilson, Patricia

2015-03-01

Clinical commissioning groups (CCGs) are required to demonstrate meaningful patient and public engagement and involvement (PPEI). Recent health service reforms have included financial incentives for general practices to develop patient reference groups (PRGs). To explore the impact of the patient participation direct enhanced service (DES) on development of PRGs, the influence of PRGs on decision making within general practice, and their interface with CCGs. A mixed-methods approach within three case study sites in England. Three case study sites were tracked for 18 months as part of an evaluation of PPEI in commissioning. A sub-study focused on PRGs utilising documentary and web-based analysis; results were mapped against findings of the main study. Evidence highlighted variations in the establishment of PRGs, with the number of active PRGs via practice websites ranging from 27% to 93%. Such groups were given a number of descriptions such as patient reference groups, patient participation groups, and patient forums. Data analysis highlighted that the mode of operation varied between virtual and tangible groups and whether they were GP- or patient-led, such analysis enabled the construction of a typology of PRGs. Evidence reviewed suggested that groups functioned within parameters of the DES with activities limited to practice level. Data analysis highlighted a lack of strategic vision in relation to such groups, particularly their role within an overall patient and PPEI framework). Findings identified diversity in the operationalisation of PRGs. Their development does not appear linked to a strategic vision or overall PPEI framework. Although local pragmatic issues are important to patients, GPs must ensure that PRGs develop strategic direction if health reforms are to be addressed. © British Journal of General Practice 2015.

Risks and advantages of using surface laser photogrammetry on free-ranging marine organisms: a case study on white sharks Carcharodon carcharias.

PubMed

Leurs, G; O'Connell, C P; Andreotti, S; Rutzen, M; Vonk Noordegraaf, H

2015-06-01

This study employed a non-lethal measurement tool, which combined an existing photo-identification technique with a surface, parallel laser photogrammetry technique, to accurately estimate the size of free-ranging white sharks Carcharodon carcharias. Findings confirmed the hypothesis that surface laser photogrammetry is more accurate than crew-based estimations that utilized a shark cage of known size as a reference tool. Furthermore, field implementation also revealed that the photographer's angle of reference and the shark's body curvature could greatly influence technique accuracy, exposing two limitations. The findings showed minor inconsistencies with previous studies that examined pre-caudal to total length ratios of dead specimens. This study suggests that surface laser photogrammetry can successfully increase length estimation accuracy and illustrates the potential utility of this technique for growth and stock assessments on free-ranging marine organisms, which will lead to an improvement of the adaptive management of the species. © 2015 The Fisheries Society of the British Isles.

Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology

PubMed Central

Mukhopadhyay, Sanjay; Feldman, Michael D.; Abels, Esther; Ashfaq, Raheela; Beltaifa, Senda; Cacciabeve, Nicolas G.; Cathro, Helen P.; Cheng, Liang; Cooper, Kumarasen; Dickey, Glenn E.; Gill, Ryan M.; Heaton, Robert P.; Kerstens, René; Lindberg, Guy M.; Malhotra, Reenu K.; Mandell, James W.; Manlucu, Ellen D.; Mills, Anne M.; Mills, Stacey E.; Moskaluk, Christopher A.; Nelis, Mischa; Patil, Deepa T.; Przybycin, Christopher G.; Reynolds, Jordan P.; Rubin, Brian P.; Saboorian, Mohammad H.; Salicru, Mauricio; Samols, Mark A.; Sturgis, Charles D.; Turner, Kevin O.; Wick, Mark R.; Yoon, Ji Y.; Zhao, Po

2018-01-01

Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of ≥4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9% for WSI and 4.6% for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4% (95% confidence interval, −0.30% to 1.01%). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8%), neoplastic kidney pathology (1.5%), urinary bladder pathology (1.3%), and gynecologic pathology (1.2%). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a wide variety of organ systems and specimen types. PMID:28961557

Validation of an algorithm to identify children with biopsy-proven celiac disease from within health administrative data: An assessment of health services utilization patterns in Ontario, Canada

PubMed Central

Chan, Jason; Mack, David R.; Manuel, Douglas G.; Mojaverian, Nassim; de Nanassy, Joseph

2017-01-01

Importance Celiac disease (CD) is a common pediatric illness, and awareness of gluten-related disorders including CD is growing. Health administrative data represents a unique opportunity to conduct population-based surveillance of this chronic condition and assess the impact of caring for children with CD on the health system. Objective The objective of the study was to validate an algorithm based on health administrative data diagnostic codes to accurately identify children with biopsy-proven CD. We also evaluated trends over time in the use of health services related to CD by children in Ontario, Canada. Study design and setting We conducted a retrospective cohort study and validation study of population-based health administrative data in Ontario, Canada. All cases of biopsy-proven CD diagnosed 2005–2011 in Ottawa were identified through chart review from a large pediatric health care center, and linked to the Ontario health administrative data to serve as positive reference standard. All other children living within Ottawa served as the negative reference standard. Case-identifying algorithms based on outpatient physician visits with associated ICD-9 code for CD plus endoscopy billing code were constructed and tested. Sensitivity, specificity, PPV and NPV were tested for each algorithm (with 95% CI). Poisson regression, adjusting for sex and age at diagnosis, was used to explore the trend in outpatient visits associated with a CD diagnostic code from 1995–2011. Results The best algorithm to identify CD consisted of an endoscopy billing claim follow by 1 or more adult or pediatric gastroenterologist encounters after the endoscopic procedure. The sensitivity, specificity, PPV, and NPV for the algorithm were: 70.4% (95% CI 61.1–78.4%), >99.9% (95% CI >99.9->99.9%), 53.3% (95% CI 45.1–61.4%) and >99.9% (95% CI >99.9->99.9%) respectively. It identified 1289 suspected CD cases from Ontario-wide administrative data. There was a 9% annual increase in the use of this combination of CD-associated diagnostic codes in physician billing data (RR 1.09, 95% CI 1.07–1.10, P<0.001). Conclusions With its current structure and variables Ontario health administrative data is not suitable in identifying incident pediatric CD cases. The tested algorithms suffer from poor sensitivity and/or poor PPV, which increase the risk of case misclassification that could lead to biased estimation of CD incidence rate. This study reinforced the importance of validating the codes used to identify cohorts or outcomes when conducting research using health administrative data. PMID:28662204

[Analysis of generic drug supply in France].

PubMed

Taboulet, F; Haramburu, F; Latry, Ph

2003-09-01

The list of generic medicines (LGM), published since 1997 by the Agence Française de Sécurité Sanitaire des Produits de Santé (AFFSSaPS), the French Medicine Agency, concerns a special part of the medicines reimbursed by the National Health Insurance (Social Security). The objectives of the present study were: i) to describe the components of this list, based on pharmaceutical, economical and therapeutic characteristics, ii) to study differences between generic and reference products (formulations, excipients, prices, etc.), iii) to analyze information on excipients provided to health care professionals. The 21st version of the LGM (April 2001) was used. Therapeutic value was retrieved from the 2001 AFSSaPS report on the therapeutic value of 4490 reimbursed medicines. Information on excipients in the LGM and the Vidal dictionary (reference prescription book in France) was compared. The products included in the LGM represent 20% of all reimbursed medicines. The mean price differences between generics and their reference products vary between 30 and 50% for more than two thirds of the generic groups. The therapeutic value of the products of the LGM was judged important in 71% of cases (vs 63% for the 4409 assessed medicines) and insufficient in 13% of cases (vs 19%). Information on excipients is often missing and sometimes erroneous. Although the LGM is regularly revised and thus the generic market in perpetual change, the 2001 cross description of this pharmaceutical market provides much informations and raises some concern.

Identification of Physician-Diagnosed Alzheimer's Disease and Related Dementias in Population-Based Administrative Data: A Validation Study Using Family Physicians' Electronic Medical Records.

PubMed

Jaakkimainen, R Liisa; Bronskill, Susan E; Tierney, Mary C; Herrmann, Nathan; Green, Diane; Young, Jacqueline; Ivers, Noah; Butt, Debra; Widdifield, Jessica; Tu, Karen

2016-08-10

Population-based surveillance of Alzheimer's and related dementias (AD-RD) incidence and prevalence is important for chronic disease management and health system capacity planning. Algorithms based on health administrative data have been successfully developed for many chronic conditions. The increasing use of electronic medical records (EMRs) by family physicians (FPs) provides a novel reference standard by which to evaluate these algorithms as FPs are the first point of contact and providers of ongoing medical care for persons with AD-RD. We used FP EMR data as the reference standard to evaluate the accuracy of population-based health administrative data in identifying older adults with AD-RD over time. This retrospective chart abstraction study used a random sample of EMRs for 3,404 adults over 65 years of age from 83 community-based FPs in Ontario, Canada. AD-RD patients identified in the EMR were used as the reference standard against which algorithms identifying cases of AD-RD in administrative databases were compared. The highest performing algorithm was "one hospitalization code OR (three physician claims codes at least 30 days apart in a two year period) OR a prescription filled for an AD-RD specific medication" with sensitivity 79.3% (confidence interval (CI) 72.9-85.8%), specificity 99.1% (CI 98.8-99.4%), positive predictive value 80.4% (CI 74.0-86.8%), and negative predictive value 99.0% (CI 98.7-99.4%). This resulted in an age- and sex-adjusted incidence of 18.1 per 1,000 persons and adjusted prevalence of 72.0 per 1,000 persons in 2010/11. Algorithms developed from health administrative data are sensitive and specific for identifying older adults with AD-RD.

Bethesda 2014: improving on a paradigm shift.

PubMed

Wilbur, D C; Nayar, R

2015-12-01

The third iteration of the Bethesda System terminology manual was recently published. This update included changes in the reporting of benign endometrial cells, and guidance for special adequacy situations and for cases in which low grade squamous intraepithelial lesions are accompanied by some cells suggesting that a high grade lesion might also be present. In addition, the manual was increased in size to include more illustrations with special studies and comparisons to histology, a greatly increased reference list, and a new chapter devoted to the modern practice of risk-based management. The third edition of the Bethesda manual is meant to serve as a primary reference for the practice of gynecologic cytology designed to provide a uniform system of reporting Worldwide for clinical, teaching, and research purposes. © 2015 John Wiley & Sons Ltd.

Descriptive Drinking Norms: For Whom Does Reference Group Matter?*

PubMed Central

Larimer, Mary E.; Neighbors, Clayton; LaBrie, Joseph W.; Atkins, David C.; Lewis, Melissa A.; Lee, Christine M.; Kilmer, Jason R.; Kaysen, Debra L.; Pedersen, Eric r.; Montoya, Heidi; Hodge, Kimberley; Desai, Sruti; Hummer, Justin F.; Walter, Theresa

2011-01-01

Objective: Perceived descriptive drinking norms often differ from actual norms and are positively related to personal consumption. However, it is not clear how normative perceptions vary with specificity of the reference group. Are drinking norms more accurate and more closely related to drinking behavior as reference group specificity increases? Do these relationships vary as a function of participant demographics? The present study examined the relationship between perceived descriptive norms and drinking behavior by ethnicity (Asian or White), sex, and fraternity/sorority status. Method: Participants were 2,699 (58% female) White (75%) or Asian (25%) undergraduates from two universities who reported their own alcohol use and perceived descriptive norms for eight reference groups: "typical student"; same sex, ethnicity, or fraternity/sorority status; and all combinations of these three factors. Results: Participants generally reported the highest perceived norms for the most distal reference group (typical student), with perceptions becoming more accurate as individuals' similarity to the reference group increased. Despite increased accuracy, participants perceived that all reference groups drank more than was actually the case. Across specific subgroups (fraternity/sorority members and men) different patterns emerged. Fraternity/sorority members reliably reported higher estimates of drinking for reference groups that included fraternity/ sorority status, and, to a lesser extent, men reported higher estimates for reference groups that included men. Conclusions: The results suggest that interventions targeting normative misperceptions may need to provide feedback based on participant demography or group membership. Although reference group-specific feedback may be important for some subgroups, typical student feedback provides the largest normative discrepancy for the majority of students. PMID:21906510

Synchronization of an optomechanical system to an external drive

NASA Astrophysics Data System (ADS)

Amitai, Ehud; Lörch, Niels; Nunnenkamp, Andreas; Walter, Stefan; Bruder, Christoph

2017-05-01

Optomechanical systems driven by an effective blue-detuned laser can exhibit self-sustained oscillations of the mechanical oscillator. These self-oscillations are a prerequisite for the observation of synchronization. Here, we study the synchronization of the mechanical oscillations to an external reference drive. We study two cases of reference drives: (1) an additional laser applied to the optical cavity; (2) a mechanical drive applied directly to the mechanical oscillator. Starting from a master equation description, we derive a microscopic Adler equation for both cases, valid in the classical regime in which the quantum shot noise of the mechanical self-oscillator does not play a role. Furthermore, we numerically show that, in both cases, synchronization arises also in the quantum regime. The optomechanical system is therefore a good candidate for the study of quantum synchronization.

Physical Science Connected Classrooms: Case Studies

ERIC Educational Resources Information Center

Irving, Karen; Sanalan, Vehbi; Shirley, Melissa

2009-01-01

Case-study descriptions of secondary and middle school classrooms in diverse contexts provide examples of how teachers implement connected classroom technology to facilitate formative assessment in science instruction. Connected classroom technology refers to a networked system of handheld devices designed for classroom use. Teachers were…

Socio economic community mapping around Dumai Timur (case study: Tanjung Palas Village)

NASA Astrophysics Data System (ADS)

Dilham, Ami; Putra, M. Umar Maya

2018-03-01

This study aimed to analyze the socio economic community mapping around Dumai Timur Sub District with a case study: Tanjung Palas Village. The problem in this research is to analyze community needs and potential contained there. The data used are primary data that have been obtained to do data entry based on the guidance from the actors concerned, there is a transfer in the form of qualitative data into quantitative measurement techniques reference instrument of socio economic mapping activities. From the results of this study indicate that the necessary empowerment of social management in which short-term policy for the addition of water discharge, training on the concept of raising entrepreneurial innovation. For the long term necessary to make a business innovation and sustainability development pattern with operational assistance in the form of seeds, the manufacture of cages and chicken feed.

Population-based evaluation of retinal nerve fiber layer, retinal ganglion cell layer, and inner plexiform layer as a diagnostic tool for glaucoma.

PubMed

Springelkamp, Henriët; Lee, Kyungmoo; Wolfs, Roger C W; Buitendijk, Gabriëlle H S; Ramdas, Wishal D; Hofman, Albert; Vingerling, Johannes R; Klaver, Caroline C W; Abràmoff, Michael D; Jansonius, Nomdo M

2014-11-20

We determined the glaucoma screening performance of regional optical coherence tomography (OCT) layer thickness measurements in the peripapillary and macular region, in a population-based setting. Subjects (n = 1224) in the Rotterdam Study underwent visual field testing (Humphrey Field Analyzer) and OCT of the macula and optic nerve head (Topcon 3-D OCT-1000). We determined the mean thicknesses of the retinal nerve fiber layer (RNFL), retinal ganglion cell layer (RGCL), and inner plexiform layer for regions-of-interest; thus, defining a series of OCT parameters, using the Iowa Reference Algorithms. Reference standard was the presence of glaucomatous visual field loss (GVFL); controls were subjects without GVFL, an intraocular pressure (IOP) of 21 mm Hg or less, and no positive family history for glaucoma. We calculated the area under the receiver operating characteristics curve (AUCs) and the sensitivity at 97.5% specificity for each parameter. After excluding 23 subjects with an IOP > 21 mm Hg and 73 subjects with a positive family history for glaucoma, there were 1087 controls and 41 glaucoma cases. Mean RGCL thickness in the inferior half of the macular region showed the highest AUC (0.85; 95% confidence interval [CI] 0.77-0.92) and sensitivity (53.7%; 95% CI, 38.7-68.0%). The mean thickness of the peripapillary RNFL had an AUC of 0.77 (95% CI, 0.69-0.85) and a sensitivity of 24.4% (95% CI, 13.7-39.5%). Macular RGCL loss is at least as common as peripapillary RNFL abnormalities in population-based glaucoma cases. Screening for glaucoma using OCT-derived regional thickness identifies approximately half of those cases of glaucoma as diagnosed by perimetry. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Quality of referral of short children to the paediatric endocrinologist and impact of a fax communication system.

PubMed

Chiniara, Lyne; Perry, Rebecca J; Van Vliet, Guy; Huot, Céline; Deal, Cheri

2013-12-01

In 2001, a chart review of children referred to the authors' endocrine clinic because of short stature revealed that many were referred with insufficient baseline data, had normal height velocity and were within genetic target height. Therefore, a two-way fax communication system was implemented between referring physicians and the authors' service before the first visit. Aspects that were assessed included whether this system increased the information accompanying the patient at referral, resulted in children with nonpathological shortness not being seen in the clinic, and was used differently by paediatricians and general practitioners. Between January and December 2006, 138 referrals for short stature, diagnosed with familial short stature, constitutional delay or idiopathic short stature, were audited (69 with and 69 without previous fax communication). Data collected included source of referral, clinical information provided, available growth measurements, and results from laboratory and imaging studies. Fax communication resulted in growth curves being provided more often (95.6% of cases versus 40.5% of cases without fax communication [P<0.001]) and more investigations being performed by the referring physician (median [range]: six [zero to 13] investigations versus one [zero to 11]; P<0.001), as well as a diagnosis of nonpathological short stature being given to 31 children based on the growth curve, laboratory and imaging results, without the children being seen in the endocrine clinic. Fax communication was also used more frequently by paediatricians (84%) than by general practitioners (15%). The fax communication system resulted in a more complete evaluation of referred patients by their physicians and reduced the number of unnecessary visits to the authors' specialty clinic while promoting medical education.

Clinical features, effectiveness of drug-based treatment, and prognosis of new daily persistent headache (NDPH): 30 cases in Japan.

PubMed

Takase, Y; Nakano, M; Tatsumi, C; Matsuyama, T

2004-11-01

Although new daily persistent headache (NDPH) is considered to be one of the most refractory headaches to pharmacological treatment, the effectiveness of drug-based treatment, and the prognosis of NDPH have not been well studied. The purpose of this study is to evaluate the effectiveness of pharmacological treatment of NDPH. Seventeen men and 13 women who met the IHS diagnostic criteria for NDPH, were treated for five years from November 1997 to October 2002, and whose headache conditions were entirely available for reference as of October 2003 were investigated in Toyonaka Municipal Hospital. Mean age at onset 35.0 years (range 13-73 years). The onset of headache occurred in relation to a stressful life event in six (20%) patients and any precipitating events could not be identified in 24 (80%) patients. For treatment, muscle relaxants were first administered and if no effect was observed, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antiepleptic drugs were subsequently administered. Results of the drug-based treatments in the 30 cases were 'very effective' for eight (27%) cases, 'moderately effective' for one (3%) case, 'mildly effective' for six (20%) cases, and 'not effective' for 15 (50%) cases. According to the survey on the phone for the patients who did not improve to the level of 'mildly effective' or better and did not come back to our institution as of October 2003, there were no cases found to have spontaneously improved to the level of 'mildly effective' or better. These results suggest that NDPH is highly recalcitrant to the treatments with poor prognosis and better treatments are needed.

DT-CWT Robust Filtering Algorithm for The Extraction of Reference and Waviness from 3-D Nano Scalar Surfaces

NASA Astrophysics Data System (ADS)

Ren, Zhi Ying.; Gao, ChengHui.; Han, GuoQiang.; Ding, Shen; Lin, JianXing.

2014-04-01

Dual tree complex wavelet transform (DT-CWT) exhibits superiority of shift invariance, directional selectivity, perfect reconstruction (PR), and limited redundancy and can effectively separate various surface components. However, in nano scale the morphology contains pits and convexities and is more complex to characterize. This paper presents an improved approach which can simultaneously separate reference and waviness and allows an image to remain robust against abnormal signals. We included a bilateral filtering (BF) stage in DT-CWT to solve imaging problems. In order to verify the feasibility of the new method and to test its performance we used a computer simulation based on three generations of Wavelet and Improved DT-CWT and we conducted two case studies. Our results show that the improved DT-CWT not only enhances the robustness filtering under the conditions of abnormal interference, but also possesses accuracy and reliability of the reference and waviness from the 3-D nano scalar surfaces.

Responding to cough presentations: an interview study with Cambodian pharmacies participating in a National Tuberculosis Referral Program.

PubMed

Bell, Carolyn A; Pichenda, Koeut; Ilomäki, Jenni; Duncan, Gregory J; Eang, Mao Tan; Saini, Bandana

2016-04-01

Asia-Pacific carries a high burden of respiratory-related mortality. Timely referral and detection of tuberculosis cases optimizes patient and public health outcomes. Registered private pharmacies in Cambodia participate in a National Tuberculosis Referral Program to refer clients with cough suggestive of tuberculosis to public sector clinics for diagnosis and care. The objective of this study was to investigate clinical intentions of pharmacy staff when presented with a hypothetical case of a client with prolonged cough suggestive of tuberculosis. A random sample of 180 pharmacies was selected. Trained interviewers administered a hypothetical case scenario to trained pharmacy staff. Participants provided 'yes'/'no' responses to five clinical actions presented in the scenario. Actions were not mutually exclusive. Data were tabulated and compared using chi-square tests or Fisher's exact tests. Overall, 156 (92%) participants would have referred the symptomatic client in the case scenario. Participants who would have referred the client were less likely to sell a cough medicine (42% vs. 100%, P < 0.001) and less likely to sell an antibiotic (19% vs. 79%, P < 0.001) than those who would not have referred the client. Involving pharmacies in a Referral Program may have introduced concepts of appropriate clinical care when responding to clients presenting with cough suggestive of tuberculosis. However, results showed enhancing clinical competence among all referral programme participants particularly among non-referring pharmacies and those making concurrent sales of cough-related products would optimize pharmacy-initiated referral. Further research into actual clinical practices at Referral Program pharmacies would be justified. © 2015 John Wiley & Sons, Ltd.

Caloric Intake, Aging, and Mild Cognitive Impairment: A Population-Based Study

PubMed Central

Geda, Yonas E.; Ragossnig, Marion; Roberts, Lewis A.; Roberts, Rosebud O.; Pankratz, V. Shane; Christianson, Teresa J.H.; Mielke, Michelle M.; Levine, James A.; Boeve, Bradley F.; Sochor, Ondřej; Tangalos, Eric G.; Knopman, David S.; Petersen, Ronald C.

2012-01-01

In a population-based case-control study, we examined whether moderate and high caloric intakes are differentially associated with the odds of having mild cognitive impairment (MCI). The sample was derived from the Mayo Clinic Study of Aging in Olmsted County, Minnesota. Non-demented study participants aged 70–92 years (1,072 cognitively normal persons and 161 subjects with MCI) reported their caloric consumption within 1 year of the date of interview by completing a Food Frequency Questionnaire. An expert consensus panel classified each subject as either cognitively normal or having MCI based on published criteria. We conducted multivariable logistic regression analyses to compute odds ratios (OR) and 95% confidence intervals (95% CI) after adjusting for age, sex, education, depression, medical comorbidity, and body mass index. We also conducted stratified analyses by apolipoprotein E ε4 genotype status. Analyses were conducted in tertiles of caloric intake: 600 to <1,526 kcals per day (reference group); 1,526 to 2,143 kcals per day (moderate caloric intake group); and >2,143 kcals per day (high caloric intake group). In the primary analysis, there was no significant difference between the moderate caloric intake group and the reference group (OR 0.87, 95% CI 0.53–1.42, p = 0.57). However, high caloric intake was associated with a nearly two-fold increased odds of having MCI (OR 1.96, 95% CI 1.26–3.06, p = 0.003) as compared to the reference group. Therefore, high caloric intake was associated with MCI but not moderate caloric intake. This association is not necessarily a cause-effect relationship. PMID:23234878

Communication: Density functional theory model for multi-reference systems based on the exact-exchange hole normalization

NASA Astrophysics Data System (ADS)

Laqua, Henryk; Kussmann, Jörg; Ochsenfeld, Christian

2018-03-01

The correct description of multi-reference electronic ground states within Kohn-Sham density functional theory (DFT) requires an ensemble-state representation, employing fractionally occupied orbitals. However, the use of fractional orbital occupation leads to non-normalized exact-exchange holes, resulting in large fractional-spin errors for conventional approximative density functionals. In this communication, we present a simple approach to directly include the exact-exchange-hole normalization into DFT. Compared to conventional functionals, our model strongly improves the description for multi-reference systems, while preserving the accuracy in the single-reference case. We analyze the performance of our proposed method at the example of spin-averaged atoms and spin-restricted bond dissociation energy surfaces.

Communication: Density functional theory model for multi-reference systems based on the exact-exchange hole normalization.

PubMed

Laqua, Henryk; Kussmann, Jörg; Ochsenfeld, Christian

2018-03-28

The correct description of multi-reference electronic ground states within Kohn-Sham density functional theory (DFT) requires an ensemble-state representation, employing fractionally occupied orbitals. However, the use of fractional orbital occupation leads to non-normalized exact-exchange holes, resulting in large fractional-spin errors for conventional approximative density functionals. In this communication, we present a simple approach to directly include the exact-exchange-hole normalization into DFT. Compared to conventional functionals, our model strongly improves the description for multi-reference systems, while preserving the accuracy in the single-reference case. We analyze the performance of our proposed method at the example of spin-averaged atoms and spin-restricted bond dissociation energy surfaces.

Awareness and uptake of direct-to-consumer genetic testing among cancer cases, their relatives, and controls: the Northwest Cancer Genetics Network.

PubMed

Hall, Taryn O; Renz, Anne D; Snapinn, Katherine W; Bowen, Deborah J; Edwards, Karen L

2012-07-01

To determine if awareness of, interest in, and use of direct-to-consumer (DTC) genetic testing is greater in a sample of high-risk individuals (cancer cases and their relatives), compared to controls. Participants were recruited from the Northwest Cancer Genetics Network. A follow-up survey was mailed to participants to assess DTC genetic testing awareness, interest, and use. One thousand two hundred sixty-seven participants responded to the survey. Forty-nine percent of respondents were aware of DTC genetic testing. Of those aware, 19% indicated interest in obtaining and <1% reported having used DTC genetic testing. Additional information supplied by respondents who reported use of DTC genetic tests indicated that 55% of these respondents likely engaged in clinical genetic testing, rather than DTC genetic testing. Awareness of DTC genetic testing was greater in our sample of high-risk individuals than in controls and population-based studies. Although interest in and use of these tests among cases in our sample were equivalent to other population-based studies, interest in testing was higher among relatives and people who self-referred for a registry focused on cancer than among cases and controls. Additionally, our results suggest that there may be some confusion about what constitutes DTC genetic testing.

An epidemiologic perspective on a case management program.

PubMed

Kahler, Deborah; Salber, Patricia; Wilson, Thomas

2010-01-01

to improve a case management (CM) program using the principles and tools of epidemiology. Specifically, to use epidemiology to describe the population being managed, to analyze factors influencing outcomes, to assess the degree to which the CM process (or intervention) is related to those outcomes, to utilize the findings in order to make recommendations (to take action) for both better evaluation and improved and more efficient CM process, to provide an estimate of the impact of the CM program based on the comparison of pre-CM and post-CM interventions, and finally to discuss the caveat that pre-CM period probably does not provide a prediction of patterns to be expected in the post-CM period had CM not been present (an ideal, but difficult-to-find referent population for this kind of effectiveness analysis). a Medicare Advantage health plan. there were a total of 12,185 individuals who met the continuous enrollment requirement of 6 months (28 days) prior to initial contact with the CM department and 6 months after the contact date: 53% were female; the average age was 73.9 (standard deviation = ± 9.5). There was a linear relationship between the average "dose" of CM-as measured by the number of times a case manager had contact with a case-and the risk profile of the case-as measured by a standard risk assessment tool provided by the Centers for Medicare & Medicaid Services. The month-to-month costs for the study population prior to CM showed a sharp rise in the month prior to the initial contact with CM and a sharp decline beginning before the contact. This pattern was consistent across different risk profiles and our operational definition of CM "dose."The average costs 6 months prior to CM were higher than the average costs 6 months after the CM. The difference in cost varied by "dose" category. When coupled with the number of cases per dosage category, the greatest value for the CM program was in the management of moderate risk cases called two to four times.However, some of the overall decline that begins prior to the initial CM contact is likely attributed to "regression to the mean" (i.e., costs may have shown a decline in spite of CM) but not all. Subsequent studies will be designed to assess the degree to which this is the case by including an equivalent referent; ideally, one that has not experienced CM or, in the absence of that, one that experienced a different kind of CM so that a valid "comparative effectiveness" study can be conducted. the "dose" of CM to its cases was in synch with an independent assessment of risk of the cases. This implies that case managers were directing their resources to those in need. However, case managers and CM processes are a limited resource and it is of interest for management to allocate those CM resources in the most efficient way possible. Methods of assessment based on individual experiences of case managers can be improved with structured, population-based assessment. These population-based tools, according to the principles of epidemiology, will be used to better allocate CM resources for optimized impact on patient populations in the future.

Defining a reference set to support methodological research in drug safety.

PubMed

Ryan, Patrick B; Schuemie, Martijn J; Welebob, Emily; Duke, Jon; Valentine, Sarah; Hartzema, Abraham G

2013-10-01

Methodological research to evaluate the performance of methods requires a benchmark to serve as a referent comparison. In drug safety, the performance of analyses of spontaneous adverse event reporting databases and observational healthcare data, such as administrative claims and electronic health records, has been limited by the lack of such standards. To establish a reference set of test cases that contain both positive and negative controls, which can serve the basis for methodological research in evaluating methods performance in identifying drug safety issues. Systematic literature review and natural language processing of structured product labeling was performed to identify evidence to support the classification of drugs as either positive controls or negative controls for four outcomes: acute liver injury, acute kidney injury, acute myocardial infarction, and upper gastrointestinal bleeding. Three-hundred and ninety-nine test cases comprised of 165 positive controls and 234 negative controls were identified across the four outcomes. The majority of positive controls for acute kidney injury and upper gastrointestinal bleeding were supported by randomized clinical trial evidence, while the majority of positive controls for acute liver injury and acute myocardial infarction were only supported based on published case reports. Literature estimates for the positive controls shows substantial variability that limits the ability to establish a reference set with known effect sizes. A reference set of test cases can be established to facilitate methodological research in drug safety. Creating a sufficient sample of drug-outcome pairs with binary classification of having no effect (negative controls) or having an increased effect (positive controls) is possible and can enable estimation of predictive accuracy through discrimination. Since the magnitude of the positive effects cannot be reliably obtained and the quality of evidence may vary across outcomes, assumptions are required to use the test cases in real data for purposes of measuring bias, mean squared error, or coverage probability.

A first comparison of the responses of a 4He-based fast-neutron detector and a NE-213 liquid-scintillator reference detector

NASA Astrophysics Data System (ADS)

Jebali, R.; Scherzinger, J.; Annand, J. R. M.; Chandra, R.; Davatz, G.; Fissum, K. G.; Friederich, H.; Gendotti, U.; Hall-Wilton, R.; Håkansson, E.; Kanaki, K.; Lundin, M.; Murer, D.; Nilsson, B.; Rosborg, A.; Svensson, H.

2015-09-01

A first comparison has been made between the pulse-shape discrimination characteristics of a novel 4He-based pressurized scintillation detector and a NE-213 liquid-scintillator reference detector using an Am/Be mixed-field neutron and gamma-ray source and a high-resolution scintillation-pulse digitizer. In particular, the capabilities of the two fast neutron detectors to discriminate between neutrons and gamma-rays were investigated. The NE-213 liquid-scintillator reference cell produced a wide range of scintillation-light yields in response to the gamma-ray field of the source. In stark contrast, due to the size and pressure of the 4He gas volume, the 4He-based detector registered a maximum scintillation-light yield of 750keVee to the same gamma-ray field. Pulse-shape discrimination for particles with scintillation-light yields of more than 750keVee was excellent in the case of the 4He-based detector. Above 750keVee its signal was unambiguously neutron, enabling particle identification based entirely upon the amount of scintillation light produced.

[Theoretical and methodological uses of research in Social and Human Sciences in Health].

PubMed

Deslandes, Suely Ferreira; Iriart, Jorge Alberto Bernstein

2012-12-01

The current article aims to map and critically reflect on the current theoretical and methodological uses of research in the subfield of social and human sciences in health. A convenience sample was used to select three Brazilian public health journals. Based on a reading of 1,128 abstracts published from 2009 to 2010, 266 articles were selected that presented the empirical base of research stemming from social and human sciences in health. The sample was classified thematically as "theoretical/ methodological reference", "study type/ methodological design", "analytical categories", "data production techniques", and "analytical procedures". We analyze the sample's emic categories, drawing on the authors' literal statements. All the classifications and respective variables were tabulated in Excel. Most of the articles were self-described as qualitative and used more than one data production technique. There was a wide variety of theoretical references, in contrast with the almost total predominance of a single type of data analysis (content analysis). In several cases, important gaps were identified in expounding the study methodology and instrumental use of the qualitative research techniques and methods. However, the review did highlight some new objects of study and innovations in theoretical and methodological approaches.

Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study

PubMed Central

Eastwood, Kathryn; Smith, Karen; Morgans, Amee; Stoelwinder, Johannes

2017-01-01

Objective To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage. Design A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage. Setting The secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4.25 million people. The Referral Service provides an in-depth secondary triage of cases classified as low acuity when calling the Australian emergency telephone number. Population Cases triaged by the Referral Service between September 2009 and June 2012 were linked to ED and hospital admission records (N=44,523). Planned ED presentations were cases referred to the ED following the secondary triage, unplanned ED presentations were cases that presented despite being referred to alternative care pathways. Main outcome measures Appropriateness was measured using an ED suitability definition and hospital admission rates. These were compared with mean population data which consisted of all of the ED presentations for the state (termed the ‘average Victorian ED presentation’). Results Planned ED presentations were more likely to be ED suitable than unplanned ED presentations (OR 1.62; 95% CI 1.5 to 1.7; p<0.001) and the average Victorian ED presentation (OR 1.85; 95% CI 1.01 to 3.4; p=0.046). They were also more likely to be admitted to the hospital than the unplanned ED presentation (OR 1.5; 95% CI 1.4 to 1.6; p<0.001) and the average Victorian ED presentation (OR 2.3, 95% CI 2.24 to 2.33; p<0.001). Just under 15% of cases diverted away from the emergency care pathways presented in the ED (unplanned ED attendances), and 9.5% of all the alternative care pathway cases were classified as ED suitable and 6.5% were admitted to hospital. Conclusions Secondary telephone triage was able to appropriately identify many ED suitable cases, and while most cases referred to alternative care pathways did not present in the ED. Further research is required to establish that these were not inappropriately triaged away from the emergency care pathways. PMID:29038180

Vorticity vector-potential method based on time-dependent curvilinear coordinates for two-dimensional rotating flows in closed configurations

NASA Astrophysics Data System (ADS)

Fu, Yuan; Zhang, Da-peng; Xie, Xi-lin

2018-04-01

In this study, a vorticity vector-potential method for two-dimensional viscous incompressible rotating driven flows is developed in the time-dependent curvilinear coordinates. The method is applicable in both inertial and non-inertial frames of reference with the advantage of a fixed and regular calculation domain. The numerical method is applied to triangle and curved triangle configurations in constant and varying rotational angular velocity cases respectively. The evolutions of flow field are studied. The geostrophic effect, unsteady effect and curvature effect on the evolutions are discussed.

Vorticity vector-potential method based on time-dependent curvilinear coordinates for two-dimensional rotating flows in closed configurations

NASA Astrophysics Data System (ADS)

Fu, Yuan; Zhang, Da-peng; Xie, Xi-lin

2018-03-01

In this study, a vorticity vector-potential method for two-dimensional viscous incompressible rotating driven flows is developed in the time-dependent curvilinear coordinates. The method is applicable in both inertial and non-inertial frames of reference with the advantage of a fixed and regular calculation domain. The numerical method is applied to triangle and curved triangle configurations in constant and varying rotational angular velocity cases respectively. The evolutions of flow field are studied. The geostrophic effect, unsteady effect and curvature effect on the evolutions are discussed.

Leprosy among schoolchildren in the Amazon region: A cross-sectional study of active search and possible source of infection by contact tracing

PubMed Central

Dias, Luiz Claudio; Galban, Enrique; Leturiondo, André; Palheta, Jamile; Santos, Monica; Moraes, Milton Ozório; Talhari, Carolina

2018-01-01

Background The high rate of leprosy cases among children under 15 years of age in Brazil indicates ongoing transmission within the community. The identification of the new leprosy cases among contacts can help identify the source of infection and interrupt the transmission chain. This study aims to determine the detection rate of previously undiagnosed cases of leprosy among schoolchildren who are under 15 years of age living in Manaus, Amazonas, Brazil, and their possible source of infection by contact tracing. Methodology/Principal findings This was a school-based, cross-sectional study in which the identification of active leprosy cases was conducted in 277 out of 622 randomly selected public schools in Manaus, Amazonas, Brazil. Suspected cases of leprosy were referred to the Alfredo da Matta Foundation, a reference center for leprosy in Manaus. A total of 34,547 schoolchildren were examined, and 40 new leprosy cases were diagnosed. Among new cases, 57.5% were males, and 80.0% demonstrated paucibacillary leprosy. A total of 196 of 206 registered contacts were screened, and 52.5% of the newly diagnosed children’s cases had at least one positive household contact. In these contacts, grandparents (52.4%) were the most common co-prevalent cases, while 14.3% were uncles, 9.5% were parents and 9.5% were granduncles. Seven contacts (5.0%), including four siblings of child patients were newly diagnosed. Our data indicate that the prevalence is 11.58 per 10,000, which is 17 times higher than the registered rate. Conclusions/Significance This study suggests that the detection rate of leprosy among schoolchildren may have remained unchanged over the past thirty years. It also indicates that that active case finding is necessary for reaching the World Health Organization’s goals of zero detection among children, especially in endemic areas where the prevalence of leprosy is obscure. Moreover, we assert that all children must have their household contacts examined in order to identify the possible source of infection and interrupt the disease’s transmission. Novel strategies to reinforce contact tracing associated with large-scale strategies of chemo- and immune-prophylaxis should be expanded to prevent the perpetuation of the disease cycle. PMID:29481570

Drug concentrations in post-mortem femoral blood compared with therapeutic concentrations in plasma

PubMed Central

Launiainen, Terhi; Ojanperä, Ilkka

2014-01-01

Therapeutic drug concentrations measured in plasma are of limited value as reference intervals for interpretation in post-mortem (PM) toxicology. In this study, drug concentration distributions were studied in PM femoral venous blood from 57 903 Finnish autopsy cases representing all causes of death during an 11-year period. Cause-of-death information was obtained from death certificates issued by forensic pathologists. Median, mean, and upper percentile (90th, 95th, 97.5th) concentrations were calculated for 129 drugs. To illustrate how PM median concentrations relate to established therapeutic ranges in plasma, a PM blood/plasma relationship was calculated for each drug. Males represented 75% of the subjects and showed a lower median age (55 yrs) than females (59 yrs). In 43% of these cases, blood alcohol concentration was higher than 0.2‰, and the median was 1.8‰. Sixty-one (47%) of the 129 drugs showed a PM blood/plasma relationship of 1. For 22 drugs (17%), the relationship was <1, and for 46 drugs (35%), the relationship was >1. No marked correlation was found between the PM blood/plasma relationship and the volume of distribution (Vd). For 36 drugs, more than 10% of cases were fatal poisonings attributed to this drug as the main finding. These drug concentration distributions based on a large database provide a helpful reference not only to forensic toxicologists and pathologists but also to clinical pharmacologists in charge of interpreting drug concentrations in PM cases. © 2013 The Authors. Drug Testing and Analysis published by John Wiley & Sons, Ltd. PMID:23881890

Particle size distributions by transmission electron microscopy: an interlaboratory comparison case study

PubMed Central

Rice, Stephen B; Chan, Christopher; Brown, Scott C; Eschbach, Peter; Han, Li; Ensor, David S; Stefaniak, Aleksandr B; Bonevich, John; Vladár, András E; Hight Walker, Angela R; Zheng, Jiwen; Starnes, Catherine; Stromberg, Arnold; Ye, Jia; Grulke, Eric A

2015-01-01

This paper reports an interlaboratory comparison that evaluated a protocol for measuring and analysing the particle size distribution of discrete, metallic, spheroidal nanoparticles using transmission electron microscopy (TEM). The study was focused on automated image capture and automated particle analysis. NIST RM8012 gold nanoparticles (30 nm nominal diameter) were measured for area-equivalent diameter distributions by eight laboratories. Statistical analysis was used to (1) assess the data quality without using size distribution reference models, (2) determine reference model parameters for different size distribution reference models and non-linear regression fitting methods and (3) assess the measurement uncertainty of a size distribution parameter by using its coefficient of variation. The interlaboratory area-equivalent diameter mean, 27.6 nm ± 2.4 nm (computed based on a normal distribution), was quite similar to the area-equivalent diameter, 27.6 nm, assigned to NIST RM8012. The lognormal reference model was the preferred choice for these particle size distributions as, for all laboratories, its parameters had lower relative standard errors (RSEs) than the other size distribution reference models tested (normal, Weibull and Rosin–Rammler–Bennett). The RSEs for the fitted standard deviations were two orders of magnitude higher than those for the fitted means, suggesting that most of the parameter estimate errors were associated with estimating the breadth of the distributions. The coefficients of variation for the interlaboratory statistics also confirmed the lognormal reference model as the preferred choice. From quasi-linear plots, the typical range for good fits between the model and cumulative number-based distributions was 1.9 fitted standard deviations less than the mean to 2.3 fitted standard deviations above the mean. Automated image capture, automated particle analysis and statistical evaluation of the data and fitting coefficients provide a framework for assessing nanoparticle size distributions using TEM for image acquisition. PMID:26361398

The Continuous Intercomparison of Radiation Codes (CIRC): Phase I Cases

NASA Technical Reports Server (NTRS)

Oreopoulos, Lazaros; Mlawer, Eli; Delamere, Jennifer; Shippert, Timothy; Turner, David D.; Miller, Mark A.; Minnis, Patrick; Clough, Shepard; Barker, Howard; Ellingson, Robert

2007-01-01

CIRC aspires to be the successor to ICRCCM (Intercomparison of Radiation Codes in Climate Models). It is envisioned as an evolving and regularly updated reference source for GCM-type radiative transfer (RT) code evaluation with the principle goal to contribute in the improvement of RT parameterizations. CIRC is jointly endorsed by DOE's Atmospheric Radiation Measurement (ARM) program and the GEWEX Radiation Panel (GRP). CIRC's goal is to provide test cases for which GCM RT algorithms should be performing at their best, i.e, well characterized clear-sky and homogeneous, overcast cloudy cases. What distinguishes CIRC from previous intercomparisons is that its pool of cases is based on observed datasets. The bulk of atmospheric and surface input as well as radiative fluxes come from ARM observations as documented in the Broadband Heating Rate Profile (BBHRP) product. BBHRP also provides reference calculations from AER's RRTM RT algorithms that can be used to select the most optimal set of cases and to provide a first-order estimate of our ability to achieve radiative flux closure given the limitations in our knowledge of the atmospheric state.

Lunar base thermal management/power system analysis and design

NASA Technical Reports Server (NTRS)

Mcghee, Jerry R.

1992-01-01

A compilation of several lunar surface thermal management and power system studies completed under contract and IR&D is presented. The work includes analysis and preliminary design of all major components of an integrated thermal management system, including loads determination, active internal acquisition and transport equipment, external transport systems (active and passive), passive insulation, solar shielding, and a range of lunar surface radiator concepts. Several computer codes were utilized in support of this study, including RADSIM to calculate radiation exchange factors and view factors, RADIATOR (developed in-house) for heat rejection system sizing and performance analysis over a lunar day, SURPWER for power system sizing, and CRYSTORE for cryogenic system performance predictions. Although much of the work was performed in support of lunar rover studies, any or all of the results can be applied to a range of surface applications. Output data include thermal loads summaries, subsystem performance data, mass, and volume estimates (where applicable), integrated and worst-case lunar day radiator size/mass and effective sink temperatures for several concepts (shielded and unshielded), and external transport system performance estimates for both single and two-phase (heat pumped) transport loops. Several advanced radiator concepts are presented, along with brief assessments of possible system benefits and potential drawbacks. System point designs are presented for several cases, executed in support of the contract and IR&D studies, although the parametric nature of the analysis is stressed to illustrate applicability of the analysis procedure to a wide variety of lunar surface systems. The reference configuration(s) derived from the various studies will be presented along with supporting criteria. A preliminary design will also be presented for the reference basing scenario, including qualitative data regarding TPS concerns and issues.

DoD Acquisition Workforce Education: An SBA Education Case Study

ERIC Educational Resources Information Center

Davenport, Richard W.

2009-01-01

A Department of Defense (DoD) M&S education task force is in the process of studying the Modeling and Simulation (M&S) education of the acquisition workforce. Historically, DoD acquisition workforce education is not referred to as education, but rather what the Defense Acquisition University (DAU) refers to as "practitioner training, career…

Design of a Golf Swing Injury Detection and Evaluation open service platform with Ontology-oriented clustering case-based reasoning mechanism.

PubMed

Ku, Hao-Hsiang

2015-01-01

Nowadays, people can easily use a smartphone to get wanted information and requested services. Hence, this study designs and proposes a Golf Swing Injury Detection and Evaluation open service platform with Ontology-oritened clustering case-based reasoning mechanism, which is called GoSIDE, based on Arduino and Open Service Gateway initative (OSGi). GoSIDE is a three-tier architecture, which is composed of Mobile Users, Application Servers and a Cloud-based Digital Convergence Server. A mobile user is with a smartphone and Kinect sensors to detect the user's Golf swing actions and to interact with iDTV. An application server is with Intelligent Golf Swing Posture Analysis Model (iGoSPAM) to check a user's Golf swing actions and to alter this user when he is with error actions. Cloud-based Digital Convergence Server is with Ontology-oriented Clustering Case-based Reasoning (CBR) for Quality of Experiences (OCC4QoE), which is designed to provide QoE services by QoE-based Ontology strategies, rules and events for this user. Furthermore, GoSIDE will automatically trigger OCC4QoE and deliver popular rules for a new user. Experiment results illustrate that GoSIDE can provide appropriate detections for Golfers. Finally, GoSIDE can be a reference model for researchers and engineers.

Risk Factors Analysis and Death Prediction in Some Life-Threatening Ailments Using Chi-Square Case-Based Reasoning (χ2 CBR) Model.

PubMed

Adeniyi, D A; Wei, Z; Yang, Y

2018-01-30

A wealth of data are available within the health care system, however, effective analysis tools for exploring the hidden patterns in these datasets are lacking. To alleviate this limitation, this paper proposes a simple but promising hybrid predictive model by suitably combining the Chi-square distance measurement with case-based reasoning technique. The study presents the realization of an automated risk calculator and death prediction in some life-threatening ailments using Chi-square case-based reasoning (χ 2 CBR) model. The proposed predictive engine is capable of reducing runtime and speeds up execution process through the use of critical χ 2 distribution value. This work also showcases the development of a novel feature selection method referred to as frequent item based rule (FIBR) method. This FIBR method is used for selecting the best feature for the proposed χ 2 CBR model at the preprocessing stage of the predictive procedures. The implementation of the proposed risk calculator is achieved through the use of an in-house developed PHP program experimented with XAMP/Apache HTTP server as hosting server. The process of data acquisition and case-based development is implemented using the MySQL application. Performance comparison between our system, the NBY, the ED-KNN, the ANN, the SVM, the Random Forest and the traditional CBR techniques shows that the quality of predictions produced by our system outperformed the baseline methods studied. The result of our experiment shows that the precision rate and predictive quality of our system in most cases are equal to or greater than 70%. Our result also shows that the proposed system executes faster than the baseline methods studied. Therefore, the proposed risk calculator is capable of providing useful, consistent, faster, accurate and efficient risk level prediction to both the patients and the physicians at any time, online and on a real-time basis.

[Saarland Growth Study: sampling design].

PubMed

Danker-Hopfe, H; Zabransky, S

2000-01-01

The use of reference data to evaluate the physical development of children and adolescents is part of the daily routine in the paediatric ambulance. The construction of such reference data is based on the collection of extensive reference data. There are different kinds of reference data: cross sectional references, which are based on data collected from a big representative cross-sectional sample of the population, longitudinal references, which are based on follow-up surveys of usually smaller samples of individuals from birth to maturity, and mixed longitudinal references, which are a combination of longitudinal and cross-sectional reference data. The advantages and disadvantages of the different methods of data collection and the resulting reference data are discussed. The Saarland Growth Study was conducted for several reasons: growth processes are subject to secular changes, there are no specific reference data for children and adolescents from this part of the country and the growth charts in use in the paediatric praxis are possibly not appropriate any more. Therefore, the Saarland Growth Study served two purposes a) to create actual regional reference data and b) to create a database for future studies on secular trends in growth processes of children and adolescents from Saarland. The present contribution focusses on general remarks on the sampling design of (cross-sectional) growth surveys and its inferences for the design of the present study.

The contribution of community health workers to the control of Buruli ulcer in the Ngoantet area, Cameroon.

PubMed

Vouking, Marius Zambou; Takougang, Innocent; Mbam, Léonard Mbam; Mbuagbaw, Lawrence; Tadenfok, Carine Nouboudem; Tamo, Claire Violette

2013-01-01

Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans. It is the third most common mycobacterial infection after tuberculosis and leprosy. Community Health Workers (CHWs) hold the potential to support patients and their families at the community level. We conducted a cross-sectional descriptive study to assess the participation of CHWs in the early diagnosis and treatment of BU in Ngoantet, Cameroon. The CHWs performance was measured using: the number of cases referred to the Ngoantet Health Centre, the percentage of accomplished referrals, the percentage of cases referred by CHWs confirmed by the staff of Ngoantet Health Centre. Data was analyzed using Epi-info version 3.4.1. and Microsoft Office Excel 2003. The study focused on 51 CHWs in the Ngoantet health area. The referral rate was 95.0%. Most of the suspicious cases (91.5%) referred were confirmed by health workers. Most CHWs (78.4%) declared that they had identified at least one presumptive case of BU infection. We conclude that the CHWs can play a key role in scaling up BU control activities using a referral system. This study confirms the role of home visits and inspections in the early detection and treatment of BU.

Model-based local density sharpening of cryo-EM maps

PubMed Central

Jakobi, Arjen J; Wilmanns, Matthias

2017-01-01

Atomic models based on high-resolution density maps are the ultimate result of the cryo-EM structure determination process. Here, we introduce a general procedure for local sharpening of cryo-EM density maps based on prior knowledge of an atomic reference structure. The procedure optimizes contrast of cryo-EM densities by amplitude scaling against the radially averaged local falloff estimated from a windowed reference model. By testing the procedure using six cryo-EM structures of TRPV1, β-galactosidase, γ-secretase, ribosome-EF-Tu complex, 20S proteasome and RNA polymerase III, we illustrate how local sharpening can increase interpretability of density maps in particular in cases of resolution variation and facilitates model building and atomic model refinement. PMID:29058676

Multicomponent blood lipid analysis by means of near infrared spectroscopy, in geese.

PubMed

Bazar, George; Eles, Viktoria; Kovacs, Zoltan; Romvari, Robert; Szabo, Andras

2016-08-01

This study provides accurate near infrared (NIR) spectroscopic models on some laboratory determined clinicochemical parameters (i.e. total lipid (5.57±1.95 g/l), triglyceride (2.59±1.36 mmol/l), total cholesterol (3.81±0.68 mmol/l), high density lipoprotein (HDL) cholesterol (2.45±0.58 mmol/l)) of blood serum samples of fattened geese. To increase the performance of multivariate chemometrics, samples significantly deviating from the regression models implying laboratory error were excluded from the final calibration datasets. Reference data of excluded samples having outlier spectra in principal component analysis were not marked as false. Samples deviating from the regression models but having non outlier spectra in PCA were identified as having false reference constituent values. Based on the NIR selection methods, 5% of the reference measurement data were rated as doubtful. The achieved models reached R(2) of 0.864, 0.966, 0.850, 0.793, and RMSE of 0.639 g/l, 0.232 mmol/l, 0.210 mmol/l, 0.241 mmol/l for total lipid, triglyceride, total cholesterol and HDL cholesterol, respectively, during independent validation. Classical analytical techniques focus on single constituents and often require chemicals, time-consuming measurements, and experienced technicians. NIR technique provides a quick, cost effective, non-hazardous alternative method for analysis of several constituents based on one single spectrum of each sample, and it also offers the possibility for looking at the laboratory reference data critically. Evaluation of reference data to identify and exclude falsely analyzed samples can provide warning feedback to the reference laboratory, especially in the case of analyses where laboratory methods are not perfectly suited to the subjected material and there is an increased chance of laboratory error. Copyright © 2016 Elsevier B.V. All rights reserved.

Understanding long-term protection of human papillomavirus vaccination against cervical carcinoma: Cancer registry-based follow-up.

PubMed

Rana, Muhammad Mohsin; Huhtala, Heini; Apter, Dan; Eriksson, Tiina; Luostarinen, Tapio; Natunen, Kari; Paavonen, Jorma; Pukkala, Eero; Lehtinen, Matti

2013-06-15

Phase III clinical trials of human papilloma virus (HPV) vaccination have shown ≥95% efficacy against HPV16/18 associated cervical intraepithelial neoplasia (CIN) Grade 2/3. Long-term surveillance is, however, needed to determine the overall vaccine efficacy (VE) against CIN3 and invasive cervical carcinoma (ICC). During population-based recruitment between September 2002 and March 2003, 1,749 16- to 17-year old Finns participated in a multi-national randomized Phase III HPV6/11/16/18 vaccine (FUTURE II) trial for the determination of VE against HPV16/18 positive CIN2/3. The passive follow-up started at the country-wide, population-based Finnish Cancer Registry (FCR) six months after the active follow-up and voluntary cross-vaccination in April 2007. A cluster randomized, population-based reference cohort of 15,744 unvaccinated, originally 18-19 year old Finns was established in two phases in 2003 and 2005 after the FUTURE II recruitment. We linked these cohorts with the FCR in 2007-2011 (HPV vaccine and placebo cohorts) and 2006-2010 and 2008-2012 (unvaccinated reference cohorts 1 and 2) to compare their incidences of CIN3 and ICC. The four years passive follow-up resulted in 3,464, 3,444 and 62,876 person years for the HPV6/11/16/18, original placebo and reference cohorts, after excluding cases discovered during the clinical follow-up and individuals not at risk. The numbers of CIN3 and ICC cases identified were 0 and 0, 3 and 0, 59 and 3 for the HPV6/11/16/18, placebo and the unvaccinated reference cohorts. The corresponding CIN3 incidence rates were 0/100,000 (95% confidence interval 0.0-106.5), 87.1/100,000 (95% CI 17.9-254.5) and 93.8/100,000 (95% CI 71.4-121), respectively. Long-term surveillance up to 8 years (and longer) post vaccination of the HPV6/11/16/18 vaccine and placebo cohorts, and the unvaccinated reference cohort (not exposed to interventions) for the most stringent efficacy end-points by passive cancer registry-based follow-up is feasible. Copyright © 2012 UICC.

Reduced variability of visual left ventricular ejection fraction assessment with reference images: The Japanese Association of Young Echocardiography Fellows multicenter study.

PubMed

Kusunose, Kenya; Shibayama, Kentaro; Iwano, Hiroyuki; Izumo, Masaki; Kagiyama, Nobuyuki; Kurosawa, Koji; Mihara, Hirotsugu; Oe, Hiroki; Onishi, Tetsuari; Onishi, Toshinari; Ota, Mitsuhiko; Sasaki, Shunsuke; Shiina, Yumi; Tsuruta, Hikaru; Tanaka, Hidekazu

2018-07-01

Visual estimation of left ventricular ejection fraction (LVEF) is widely applied to confirm quantitative EF. However, visual assessment is subjective, and variability may be influenced by observer experience. We hypothesized that a learning session might reduce the misclassification rate. Protocol 1: Visual LVEFs for 30 cases were measured by 79 readers from 13 cardiovascular tertiary care centers. Readers were divided into 3 groups by their experience: limited (1-5 years, n=28), intermediate (6-11 years, n=26), and highly experienced (12-years, n=25). Protocol 2: All readers were randomized to assess the effect of a learning session with reference images only or feedback plus reference images. After the session, 20 new cases were shown to all readers following the same methodology. To assess the concordance and accuracy pre- and post-intervention, each visual LVEF measurement was compared to overall average values as a reference. Experience affected the concordance in visual EF values among the readers. Groups with intermediate and high experience showed significantly better mean difference (MD), standard deviation (SD), and coefficient of variation (CV) than those with limited experience at baseline. The learning session with reference image reduced the MD, SD, and CV in readers with limited experience. The learning session with reference images plus feedback also reduced proportional bias. Importantly, the misclassification rate for mid-range EF cases was reduced regardless of experience. This large multicenter study suggested that a simple learning session with reference images can successfully reduce the misclassification rate for LVEF assessment. Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Combined estimation of kappa and shear-wave velocity profile of the Japanese rock reference

NASA Astrophysics Data System (ADS)

Poggi, Valerio; Edwards, Benjamin; Fäh, Donat

2013-04-01

The definition of a common soil or rock reference is a key issue in probabilistic seismic hazard analysis (PSHA), microzonation studies, local site-response analysis and, more generally, when predicted or observed ground motion is compared for sites of different characteristics. A scaling procedure, which accounts for a common reference, is then necessary to avoid bias induced by the differences in the local geology. Nowadays methods requiring the definition of a reference condition generally prescribe the characteristic of a rock reference, calibrated using indirect estimation methods based on geology or on surface proxies. In most cases, a unique average shear-wave velocity value is prescribed (e.g. Vs30 = 800m/s as for class A of the EUROCODE8). Some attempts at defining the whole shape of a reference rock velocity profile have been described, often without a clear physical justification of how such a selection was performed. Moreover, in spite of its relevance in affecting the high-frequency part of the spectrum, the definition of the associated reference attenuation is in most cases missing or, when present, still remains quite uncertain. In this study we propose an approach that is based on the comparison between empirical anelastic amplification functions from spectral modeling of earthquakes and average S-wave velocities computed using the quarter-wavelength approach. The method is an extension of the approach originally proposed by Poggi et al. (2011) for Switzerland, and is here applied to Japan. For the analysis we make use of a selection of 36 stiff-soil and rock sites from the Japanese KiK-net network, for which a measured velocity profile is available. With respect to the previous study, however, we now analyze separately the elastic and anelastic contributions of the estimated empirical amplification. In a first step - which is consistent with the original work - only the elastic part of the amplification spectrum is considered. This procedure allows the retrieval of the shape of the velocity profile that is characterized by no relative amplification within the network. Subsequently, the contribution of intrinsic attenuation is analyzed, disaggregated from the anelastic function by using the frequency independent (and site-dependent) attenuation operator kappa (κ). By comparing the dependency of κ with the quarter-wavelength velocity at selected sites, a frequency-dependent predictive equation is established to model the attenuation characteristics of an arbitrary rock or stiff-soil velocity model, such as the reference model obtained in the first step. The result of this application can be used to model the site-dependent attenuation for any rock and stiff-soil site for which an estimation of the velocity profile or its corresponding quarter-wavelength velocity representation is available. As an additional output of the present study, we also propose a simplified method to estimate kappa from the average velocity estimates over the first 30m (Vs30). We provide an example of such predictions for a range of Vs30 velocities up to 2000m/s.

Accuracy of metric sex analysis of skeletal remains using Fordisc based on a recent skull collection.

PubMed

Ramsthaler, F; Kreutz, K; Verhoff, M A

2007-11-01

It has been generally accepted in skeletal sex determination that the use of metric methods is limited due to the population dependence of the multivariate algorithms. The aim of the study was to verify the applicability of software-based sex estimations outside the reference population group for which discriminant equations have been developed. We examined 98 skulls from recent forensic cases of known age, sex, and Caucasian ancestry from cranium collections in Frankfurt and Mainz (Germany) to determine the accuracy of sex determination using the statistical software solution Fordisc which derives its database and functions from the US American Forensic Database. In a comparison between metric analysis using Fordisc and morphological determination of sex, average accuracy for both sexes was 86 vs 94%, respectively, and males were identified more accurately than females. The ratio of the true test result rate to the false test result rate was not statistically different for the two methodological approaches at a significance level of 0.05 but was statistically different at a level of 0.10 (p=0.06). Possible explanations for this difference comprise different ancestry, age distribution, and socio-economic status compared to the Fordisc reference sample. It is likely that a discriminant function analysis on the basis of more similar European reference samples will lead to more valid and reliable sexing results. The use of Fordisc as a single method for the estimation of sex of recent skeletal remains in Europe cannot be recommended without additional morphological assessment and without a built-in software update based on modern European reference samples.

Using existing case-mix methods to fund trauma cases.

PubMed

Monakova, Julia; Blais, Irene; Botz, Charles; Chechulin, Yuriy; Picciano, Gino; Basinski, Antoni

2010-01-01

Policymakers frequently face the need to increase funding in isolated and frequently heterogeneous (clinically and in terms of resource consumption) patient subpopulations. This article presents a methodologic solution for testing the appropriateness of using existing grouping and weighting methodologies for funding subsets of patients in the scenario where a case-mix approach is preferable to a flat-rate based payment system. Using as an example the subpopulation of trauma cases of Ontario lead trauma hospitals, the statistical techniques of linear and nonlinear regression models, regression trees, and spline models were applied to examine the fit of the existing case-mix groups and reference weights for the trauma cases. The analyses demonstrated that for funding Ontario trauma cases, the existing case-mix systems can form the basis for rational and equitable hospital funding, decreasing the need to develop a different grouper for this subset of patients. This study confirmed that Injury Severity Score is a poor predictor of costs for trauma patients. Although our analysis used the Canadian case-mix classification system and cost weights, the demonstrated concept of using existing case-mix systems to develop funding rates for specific subsets of patient populations may be applicable internationally.

Historical trends and high-resolution future climate projections in northern Tuscany (Italy)

NASA Astrophysics Data System (ADS)

D'Oria, Marco; Ferraresi, Massimo; Tanda, Maria Giovanna

2017-12-01

This paper analyzes the historical precipitation and temperature trends and the future climate projections with reference to the northern part of Tuscany (Italy). The trends are identified and quantified at monthly and annual scale at gauging stations with data collected for long periods (60-90 years). An ensemble of 13 Regional Climate Models (RCMs), based on two Representative Concentration Pathways (RCP4.5 and RCP8.5), was then used to assess local scale future precipitation and temperature projections and to represent the uncertainty in the results. The historical data highlight a general decrease of the annual rainfall at a mean rate of 22 mm per decade but, in many cases, the tendencies are not statistically significant. Conversely, the annual mean temperature exhibits an upward trend, statistically significant in the majority of cases, with a warming rate of about 0.1 °C per decade. With reference to the model projections and the annual precipitation, the results are not concordant; the deviations between models in the same period are higher than the future changes at medium- (2031-2040) and long-term (2051-2060) and highlight that the model uncertainty and variability is high. According to the climate model projections, the warming of the study area is unequivocal; a mean positive increment of 0.8 °C at medium-term and 1.1 °C at long-term is expected with respect to the reference period (2003-2012) and the scenario RCP4.5; the increments grow to 0.9 °C and 1.9 °C for the RCP8.5. Finally, in order to check the observed climate change signals, the climate model projections were compared with the trends based on the historical data. A satisfactory agreement is obtained with reference to the precipitation; a systematic underestimation of the trend values with respect to the models, at medium- and long-term, is observed for the temperature data.

Utility of additional tissue sections in dermatopathology: diagnostic, clinical and financial implications.

PubMed

Stuart, Lauren N; Rodriguez, Adrianna S; Gardner, Jerad M; Foster, Toby E; MacKelfresh, Jamie; Parker, Douglas C; Chen, Suephy C; Stoff, Benjamin K

2014-02-01

As histopathologic assessment is subject to sampling error, some institutions 'preorder' deeper sections on some or all cases (hereafter referred to as prospective deeper sections), while others order additional sections only when needed (hereafter referred to as retrospective deeper sections). We investigated how often additional sections changed a diagnosis and/or clinical management. Given the recent decrease in reimbursement for CPT-code 88305, we also considered the financial implications of ordering additional sections. Cases (n = 204) were assigned a preliminary diagnosis, based on review of the initial slide, and a final diagnosis, after reviewing additional sections. Cases with discordant diagnoses were assessed by two dermatologists, who indicated whether the change in diagnosis altered clinical management. Expenses were estimated for three scenarios: (a) no additional sections, (b) prospective deeper sections and (c) retrospective deeper sections. Diagnoses were modified in 9% of cases, which changed clinical management in 56% of these cases. Lesions obtained by punch-biopsy and inflammatory lesions were disproportionately overrepresented amongst cases with changed diagnoses (p < 0.001, p = 0.12, respectively). The cost of prospective deeper sections and retrospective deeper sections represented a 56% and 115% increase over base costs, respectively. Labor costs, particularly the cost of dermatopathologist evaluation, were the most significant cost-drivers. While additional sections improve diagnostic accuracy, they delay turn-around-time and increase expenditures. In our practice, prospective deeper sections are cost effective, however, this may vary by institution. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis.

PubMed

Poorolajal, Jalal; Haghtalab, Tahereh; Farhadi, Mehran; Darvishi, Nahid

2016-09-01

This meta-analysis addressed the association between substance use disorder (SUD) and suicide outcomes based on current evidence. We searched PubMed, Web of Science and Scopus until May 2015. We also searched the reference lists of included studies and Psycinfo website. We included observational (cohort, case-control, cross-sectional) studies addressing the association between SUD and suicide. Our outcomes of interest were suicide ideation, suicide attempt and suicide death. For each outcome, we calculated the odds ratio (OR) or risk ratio (RR) with 95% confidence intervals (CI) based on the random-effects model. We identified a total of 12 413 references and included 43 studies with 870 967 participants. There was a significant association between SUD and suicidal ideation: OR 2.04 (95% CI: 1.59, 2.50; I 2 = 88.8%, 16 studies); suicide attempt OR 2.49 (95% CI: 2.00, 2.98; I 2 = 94.3%, 24 studies) and suicide death OR 1.49 (95% CI: 0.97, 2.00; I 2 = 82.7%, 7 studies). Based on current evidence, there is a strong association between SUD and suicide outcomes. However, evidence based on long-term prospective cohort studies is limited and needs further investigation. Moreover, further evidence is required to assess and compare the association between suicide outcomes and different types of illicit drugs, dose-response relationship and the way they are used. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Dissolution curve comparisons through the F(2) parameter, a Bayesian extension of the f(2) statistic.

PubMed

Novick, Steven; Shen, Yan; Yang, Harry; Peterson, John; LeBlond, Dave; Altan, Stan

2015-01-01

Dissolution (or in vitro release) studies constitute an important aspect of pharmaceutical drug development. One important use of such studies is for justifying a biowaiver for post-approval changes which requires establishing equivalence between the new and old product. We propose a statistically rigorous modeling approach for this purpose based on the estimation of what we refer to as the F2 parameter, an extension of the commonly used f2 statistic. A Bayesian test procedure is proposed in relation to a set of composite hypotheses that capture the similarity requirement on the absolute mean differences between test and reference dissolution profiles. Several examples are provided to illustrate the application. Results of our simulation study comparing the performance of f2 and the proposed method show that our Bayesian approach is comparable to or in many cases superior to the f2 statistic as a decision rule. Further useful extensions of the method, such as the use of continuous-time dissolution modeling, are considered.

Model-based control strategies for systems with constraints of the program type

NASA Astrophysics Data System (ADS)

Jarzębowska, Elżbieta

2006-08-01

The paper presents a model-based tracking control strategy for constrained mechanical systems. Constraints we consider can be material and non-material ones referred to as program constraints. The program constraint equations represent tasks put upon system motions and they can be differential equations of orders higher than one or two, and be non-integrable. The tracking control strategy relies upon two dynamic models: a reference model, which is a dynamic model of a system with arbitrary order differential constraints and a dynamic control model. The reference model serves as a motion planner, which generates inputs to the dynamic control model. It is based upon a generalized program motion equations (GPME) method. The method enables to combine material and program constraints and merge them both into the motion equations. Lagrange's equations with multipliers are the peculiar case of the GPME, since they can be applied to systems with constraints of first orders. Our tracking strategy referred to as a model reference program motion tracking control strategy enables tracking of any program motion predefined by the program constraints. It extends the "trajectory tracking" to the "program motion tracking". We also demonstrate that our tracking strategy can be extended to a hybrid program motion/force tracking.

Comparison of two optimized readout chains for low light CIS

NASA Astrophysics Data System (ADS)

Boukhayma, A.; Peizerat, A.; Dupret, A.; Enz, C.

2014-03-01

We compare the noise performance of two optimized readout chains that are based on 4T pixels and featuring the same bandwidth of 265kHz (enough to read 1Megapixel with 50frame/s). Both chains contain a 4T pixel, a column amplifier and a single slope analog-to-digital converter operating a CDS. In one case, the pixel operates in source follower configuration, and in common source configuration in the other case. Based on analytical noise calculation of both readout chains, an optimization methodology is presented. Analytical results are confirmed by transient simulations using 130nm process. A total input referred noise bellow 0.4 electrons RMS is reached for a simulated conversion gain of 160μV/e-. Both optimized readout chains show the same input referred 1/f noise. The common source based readout chain shows better performance for thermal noise and requires smaller silicon area. We discuss the possible drawbacks of the common source configuration and provide the reader with a comparative table between the two readout chains. The table contains several variants (column amplifier gain, in-pixel transistor sizes and type).

No Sunset and Extended Policies Cases (released in AEO2010)

EIA Publications

2010-01-01

The Annual Energy Outlook 2010 Reference case is best described as a current laws and regulations case, because it generally assumes that existing laws and fully promulgated regulations will remain unchanged throughout the projection period, unless the legislation establishing them specifically calls for them to end or change. The Reference case often serves as a starting point for the analysis of proposed legislative or regulatory changes, a task that would be difficult if the Reference case included projected legislative or regulatory changes.

5 CFR 2638.504 - Director's finding.

Code of Federal Regulations, 2010 CFR

2010-01-01

... facts upon which the finding is based and a reference to the specific ethics provision in issue. A copy....504 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS OFFICE OF GOVERNMENT ETHICS AND EXECUTIVE AGENCY ETHICS PROGRAM RESPONSIBILITIES Corrective and Remedial Action in Cases Involving...

A systematic review of validated methods to capture myopericarditis using administrative or claims data.

PubMed

Idowu, Rachel T; Carnahan, Ryan; Sathe, Nila A; McPheeters, Melissa L

2013-12-30

To identify algorithms that can capture incident cases of myocarditis and pericarditis in administrative and claims databases; these algorithms can eventually be used to identify cardiac inflammatory adverse events following vaccine administration. We searched MEDLINE from 1991 to September 2012 using controlled vocabulary and key terms related to myocarditis. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics as well as study conduct. Nine publications (including one study reported in two publications) met criteria for inclusion. Two studies performed medical record review in order to confirm that these coding algorithms actually captured patients with the disease of interest. One of these studies identified five potential cases, none of which were confirmed as acute myocarditis upon review. The other study, which employed a search algorithm based on diagnostic surveillance (using ICD-9 codes 420.90, 420.99, 422.90, 422.91 and 429.0) and sentinel reporting, identified 59 clinically confirmed cases of myopericarditis among 492,671 United States military service personnel who received smallpox vaccine between 2002 and 2003. Neither study provided algorithm validation statistics (positive predictive value, sensitivity, or specificity). A validated search algorithm is currently unavailable for identifying incident cases of pericarditis or myocarditis. Several authors have published unvalidated ICD-9-based search algorithms that appear to capture myocarditis events occurring in the context of other underlying cardiac or autoimmune conditions. Copyright © 2013. Published by Elsevier Ltd.

A population-based registry as a source of health indicators for rare diseases: the ten-year experience of the Veneto Region’s rare diseases registry

PubMed Central

2014-01-01

Background Although rare diseases have become a major public health issue, there is a paucity of population-based data on rare diseases. The aim of this epidemiological study was to provide descriptive figures referring to a sizable group of unrelated rare diseases. Methods Data from the rare diseases registry established in the Veneto Region of north-east Italy (population 4,900,000), referring to the years from 2002 to 2012, were analyzed. The registry is based on a web-based system accessed by different users. Cases are enrolled by two different sources: clinicians working at Centers of expertise officially designated to diagnose and care patients with rare diseases and health professionals working in the local health districts. Deaths of patients are monitored by Death Registry. Results So far, 19,547 patients with rare diseases have been registered, and 23% of them are pediatric cases. The overall raw prevalence of the rare diseases monitored in the population under study is 33.09 per 10,000 inhabitants (95% CI 32.56-33.62), whilst the overall incidence is 3.85 per 10,000 inhabitants (95% CI 3.67-4.03). The most commonly-recorded diagnoses belong to the following nosological groups: congenital malformations (Prevalence: 5.45/10,000), hematological diseases (4.83/10,000), ocular disorders (4.47/10,000), diseases of the nervous system (3.51/10,000), and metabolic disorders (2,95/10,000). Most of the deaths in the study population occur among pediatric patients with congenital malformations, and among adult cases with neurological diseases. Rare diseases of the central nervous system carry the highest fatality rate (71.36/1,000). Rare diseases explain 4.2% of general population Years of Life Lost (YLLs), comparing to 1.2% attributable to infectious diseases and 2.6% to diabetes mellitus. Conclusions Our estimates of the burden of rare diseases at population level confirm that these conditions are a relevant public health issue. Our snapshot of their epidemiology is important for public health planning purposes, going to show that population-based registries are useful tools for generating health indicators relating to a considerable number of rare diseases, rather than to specific conditions. PMID:24646171

A Varian DynaLog file-based procedure for patient dose-volume histogram-based IMRT QA.

PubMed

Calvo-Ortega, Juan F; Teke, Tony; Moragues, Sandra; Pozo, Miquel; Casals-Farran, Joan

2014-03-06

In the present study, we describe a method based on the analysis of the dynamic MLC log files (DynaLog) generated by the controller of a Varian linear accelerator in order to perform patient-specific IMRT QA. The DynaLog files of a Varian Millennium MLC, recorded during an IMRT treatment, can be processed using a MATLAB-based code in order to generate the actual fluence for each beam and so recalculate the actual patient dose distribution using the Eclipse treatment planning system. The accuracy of the DynaLog-based dose reconstruction procedure was assessed by introducing ten intended errors to perturb the fluence of the beams of a reference plan such that ten subsequent erroneous plans were generated. In-phantom measurements with an ionization chamber (ion chamber) and planar dose measurements using an EPID system were performed to investigate the correlation between the measured dose changes and the expected ones detected by the reconstructed plans for the ten intended erroneous cases. Moreover, the method was applied to 20 cases of clinical plans for different locations (prostate, lung, breast, and head and neck). A dose-volume histogram (DVH) metric was used to evaluate the impact of the delivery errors in terms of dose to the patient. The ionometric measurements revealed a significant positive correlation (R² = 0.9993) between the variations of the dose induced in the erroneous plans with respect to the reference plan and the corresponding changes indicated by the DynaLog-based reconstructed plans. The EPID measurements showed that the accuracy of the DynaLog-based method to reconstruct the beam fluence was comparable with the dosimetric resolution of the portal dosimetry used in this work (3%/3 mm). The DynaLog-based reconstruction method described in this study is a suitable tool to perform a patient-specific IMRT QA. This method allows us to perform patient-specific IMRT QA by evaluating the result based on the DVH metric of the planning CT image (patient DVH-based IMRT QA).

ECHO: A reference-free short-read error correction algorithm

PubMed Central

Kao, Wei-Chun; Chan, Andrew H.; Song, Yun S.

2011-01-01

Developing accurate, scalable algorithms to improve data quality is an important computational challenge associated with recent advances in high-throughput sequencing technology. In this study, a novel error-correction algorithm, called ECHO, is introduced for correcting base-call errors in short-reads, without the need of a reference genome. Unlike most previous methods, ECHO does not require the user to specify parameters of which optimal values are typically unknown a priori. ECHO automatically sets the parameters in the assumed model and estimates error characteristics specific to each sequencing run, while maintaining a running time that is within the range of practical use. ECHO is based on a probabilistic model and is able to assign a quality score to each corrected base. Furthermore, it explicitly models heterozygosity in diploid genomes and provides a reference-free method for detecting bases that originated from heterozygous sites. On both real and simulated data, ECHO is able to improve the accuracy of previous error-correction methods by several folds to an order of magnitude, depending on the sequence coverage depth and the position in the read. The improvement is most pronounced toward the end of the read, where previous methods become noticeably less effective. Using a whole-genome yeast data set, it is demonstrated here that ECHO is capable of coping with nonuniform coverage. Also, it is shown that using ECHO to perform error correction as a preprocessing step considerably facilitates de novo assembly, particularly in the case of low-to-moderate sequence coverage depth. PMID:21482625

Dynamic optical imaging of vascular and metabolic reactivity in rheumatoid joints.

PubMed

Lasker, Joseph M; Fong, Christopher J; Ginat, Daniel T; Dwyer, Edward; Hielscher, Andreas H

2007-01-01

Dynamic optical imaging is increasingly applied to clinically relevant areas such as brain and cancer imaging. In this approach, some external stimulus is applied and changes in relevant physiological parameters (e.g., oxy- or deoxyhemoglobin concentrations) are determined. The advantage of this approach is that the prestimulus state can be used as a reference or baseline against which the changes can be calibrated. Here we present the first application of this method to the problem of characterizing joint diseases, especially effects of rheumatoid arthritis (RA) in the proximal interphalangeal finger joints. Using a dual-wavelength tomographic imaging system together with previously implemented model-based iterative image reconstruction schemes, we have performed initial dynamic imaging case studies on a limited number of healthy volunteers and patients diagnosed with RA. Focusing on three cases studies, we illustrated our major finds. These studies support our hypothesis that differences in the vascular reactivity exist between affected and unaffected joints.

Slow reception and under-citedness in climate change research: A case study of Charles David Keeling, discoverer of the risk of global warming.

PubMed

Marx, Werner; Haunschild, Robin; French, Bernie; Bornmann, Lutz

2017-01-01

The Keeling curve has become a chemical landmark, whereas the papers by Charles David Keeling about the underlying carbon dioxide measurements are not cited as often as can be expected against the backdrop of his final approval. In this bibliometric study, we analyze Keeling's papers as a case study for under-citedness of climate change publications. Three possible reasons for the under-citedness of Keeling's papers are discussed: (1) The discourse on global cooling at the starting time of Keeling's measurement program, (2) the underestimation of what is often seen as "routine science", and (3) the amount of implicit/informal citations at the expense of explicit/formal (reference-based) citations. Those reasons may have contributed more or less to the slow reception and the under-citedness of Keeling's seminal works.

The contribution of different information sources for adverse effects data.

PubMed

Golder, Su; Loke, Yoon K

2012-04-01

The aim of this study is to determine the relative value and contribution of searching different sources to identify adverse effects data. The process of updating a systematic review and meta-analysis of thiazolidinedione-related fractures in patients with type 2 diabetes mellitus was used as a case study. For each source searched, a record was made for each relevant reference included in the review noting whether it was retrieved with the search strategy used and whether it was available but not retrieved. The sensitivity, precision, and number needed to read from searching each source and from different combinations of sources were also calculated. There were 58 relevant references which presented sufficient numerical data to be included in a meta-analysis of fractures and bone mineral density. The highest number of relevant references were retrieved from Science Citation Index (SCI) (35), followed by BIOSIS Previews (27) and EMBASE (24). The precision of the searches varied from 0.88% (Scirus) to 41.67% (CENTRAL). With the search strategies used, the minimum combination of sources required to retrieve all the relevant references was; the GlaxoSmithKline (GSK) website, Science Citation Index (SCI), EMBASE, BIOSIS Previews, British Library Direct, Medscape DrugInfo, handsearching and reference checking, AHFS First, and Thomson Reuters Integrity or Conference Papers Index (CPI). In order to identify all the relevant references for this case study a number of different sources needed to be searched. The minimum combination of sources required to identify all the relevant references did not include MEDLINE.

Additive Partial Least Squares for efficient modelling of independent variance sources demonstrated on practical case studies.

PubMed

Luoma, Pekka; Natschläger, Thomas; Malli, Birgit; Pawliczek, Marcin; Brandstetter, Markus

2018-05-12

A model recalibration method based on additive Partial Least Squares (PLS) regression is generalized for multi-adjustment scenarios of independent variance sources (referred to as additive PLS - aPLS). aPLS allows for effortless model readjustment under changing measurement conditions and the combination of independent variance sources with the initial model by means of additive modelling. We demonstrate these distinguishing features on two NIR spectroscopic case-studies. In case study 1 aPLS was used as a readjustment method for an emerging offset. The achieved RMS error of prediction (1.91 a.u.) was of similar level as before the offset occurred (2.11 a.u.). In case-study 2 a calibration combining different variance sources was conducted. The achieved performance was of sufficient level with an absolute error being better than 0.8% of the mean concentration, therefore being able to compensate negative effects of two independent variance sources. The presented results show the applicability of the aPLS approach. The main advantages of the method are that the original model stays unadjusted and that the modelling is conducted on concrete changes in the spectra thus supporting efficient (in most cases straightforward) modelling. Additionally, the method is put into context of existing machine learning algorithms. Copyright © 2018 Elsevier B.V. All rights reserved.

Case-Control Pilot Study on Acute Diarrheal Disease in a Geographically Defined Pediatric Population in a Middle Income Country

PubMed Central

Farfán-García, Ana E.; Zhang, Chengxian; Imdad, Aamer; Arias-Guerrero, Monica Y.; Sánchez-Alvarez, Nayibe T.; Shah, Rikhil; Iqbal, Junaid; Tamborski, Maria E.

2017-01-01

Introduction Acute diarrheal disease (ADD) is a common cause of morbidity and mortality in children under 5 years of age. Understanding of the etiology of ADD is lacking in most low and middle income countries because reference laboratories detect limited number of pathogens. The objective of this study was to determine the feasibility to conduct a comprehensive case-control study to survey diarrheal pathogens among children with and without moderate-to-severe ADD. Materials and Methods Microbiology and molecular-based techniques were used to detect viral, bacterial, and parasitic enteropathogens. The study was conducted in Bucaramanga, Colombia, after Institutional Review Board approval was obtained. Results Ninety children less than 5 years of age were recruited after a written informed consent was obtained from parents or guardians. Forty-five subjects served as cases with ADD and 45 as controls. Thirty-six subjects out of 90 (40.0%) were positive for at least one enteropathogen, that is, 20 (44.4%) cases and 16 (35.5%) controls. Conclusions The three most common enteric pathogens were enteroaggregative E. coli (10.0%), Norovirus (6.7%), and Salmonella spp. (5.6%). The E. coli pathogens were 18.8% of all infections making them the most frequent pathogens. Half of ADD cases were negative for any pathogens. PMID:28855919

Development and Applications of Advanced Electronic Structure Methods

NASA Astrophysics Data System (ADS)

Bell, Franziska

This dissertation contributes to three different areas in electronic structure theory. The first part of this thesis advances the fundamentals of orbital active spaces. Orbital active spaces are not only essential in multi-reference approaches, but have also become of interest in single-reference methods as they allow otherwise intractably large systems to be studied. However, despite their great importance, the optimal choice and, more importantly, their physical significance are still not fully understood. In order to address this problem, we studied the higher-order singular value decomposition (HOSVD) in the context of electronic structure methods. We were able to gain a physical understanding of the resulting orbitals and proved a connection to unrelaxed natural orbitals in the case of Moller-Plesset perturbation theory to second order (MP2). In the quest to find the optimal choice of the active space, we proposed a HOSVD for energy-weighted integrals, which yielded the fastest convergence in MP2 correlation energy for small- to medium-sized active spaces to date, and is also potentially transferable to coupled-cluster theory. In the second part, we studied monomeric and dimeric glycerol radical cations and their photo-induced dissociation in collaboration with Prof. Leone and his group. Understanding the mechanistic details involved in these processes are essential for further studies on the combustion of glycerol and carbohydrates. To our surprise, we found that in most cases, the experimentally observed appearance energies arise from the separation of product fragments from one another rather than rearrangement to products. The final chapters of this work focus on the development, assessment, and application of the spin-flip method, which is a single-reference approach, but capable of describing multi-reference problems. Systems exhibiting multi-reference character, which arises from the (near-) degeneracy of orbital energies, are amongst the most interesting in chemistry, biology and materials science, yet amongst the most challenging to study with electronic structure methods. In particular, we explored a substituted dimeric BPBP molecule with potential tetraradical character, which gained attention as one of the most promising candidates for an organic conductor. Furthermore, we extended the spin-flip approach to include variable orbital active spaces and multiple spin-flips. This allowed us to perform wave-function-based studies of ground- and excited-states of polynuclear metal complexes, polyradicals, and bond-dissociation processes involving three or more bonds.

Individual Differences in Pronoun Reversal: Evidence from Two Longitudinal Case Studies

ERIC Educational Resources Information Center

Evans, Karen E.; Demuth, Katherine

2012-01-01

Pronoun reversal, the use of "you" for self-reference and "I" for an addressee, has often been associated with Autism Spectrum Disorder (ASD) and impaired language. However, recent case studies have shown the phenomenon also to occur in typically developing and even precocious talkers. This study examines longitudinal corpus data from two…

The Influence of Ballistic Damage on the Aeroelastic Characteristics of Lifting Surfaces.

DTIC Science & Technology

1979-07-01

the pressure distribution. The finite-element method, often referred to as a vortex- lattice or doublet- lattice method, divides the lifting surface into...finite-element modeling, such as doublet- lattice , would provide a better understanding of the near-field effects of a damage hole and allow a data base...0.17 0.33 0.50 6.67 0.833 1.00 Figure 42 125 CASE 5 and CASE 5D 0 Ye=.57 = UNDAMAGED M = DAMAGED 0 C3/ C22 CD QCD 6.330,4 0/ Fiue4 02 CASE 5 and CASE

Serum levels of C-reactive protein in adolescents with periodontitis.

PubMed

López, Rodrigo; Baelum, Vibeke; Hedegaard, Chris Juul; Bendtzen, Klaus

2011-04-01

The results of several cross-sectional studies suggested a relationship between periodontitis and higher serum levels of C-reactive protein (CRP). Most of these studies were restricted to adult study groups with severe periodontal inflammation, and the potential effects of confounding factors were frequently overlooked. A case-referent study comprised of 87 adolescent cases who presented with clinical attachment loss ≥3 mm recorded in ≥2 of 16 teeth and 73 controls who did not fulfill these criteria was nested in a fully enumerated adolescent population. Venous blood samples were obtained, and CRP levels were quantified, using a high-sensitive bead-based flow cytometric assay. The Mann-Whitney U test was used to assess overall differences between groups. The median serum CRP values for cases and controls were 64 ng/ml (interquartile range: 27 to 234 ng/ml) and 55 ng/ml (31 to 183 ng/ml), respectively (P = 0.8). Serum levels of CRP were not significantly higher among subjects with periodontitis than among controls. However, a statistically significant positive association between percentages of sites with bleeding on probing and log-transformed CRP values was observed.

The impact of legal vulnerability on environmental inequalities. A case study of coastal populations in Guadeloupe (French Antilles)

NASA Astrophysics Data System (ADS)

Claeys, Cécilia; Arnaud, Aurélie; Lambert, Marie-Laure

2017-10-01

This paper draws on sociology, geography and law to analyse the exposure of populations to coastal multihazards in a postcolonial and overseas context. The research is based on a case study conducted in two municipalities in Guadeloupe (French Antilles): Deshaies and Capesterre-Belle-Eau. The corpus of data consists of 52 interviews conducted with inhabitants and institutional actors, as well as a set of spatialized data and a regulatory corpus. The analysis underscores how public policies must contend with a complex territorial reality that is still bound to the postcolonial past and legacy of slavery in Guadeloupe. The potential contradictions between regularization policies, hazard prevention policies and policies to curb insalubrious housing tend to expose the most fragile populations to what we refer to here as legal vulnerability.

Social influences on adolescents' dietary behavior in Catalonia, Spain: A qualitative multiple-cases study from the perspective of social capital.

PubMed

Carrillo-Álvarez, Elena; Riera-Romaní, Jordi; Canet-Vélez, Olga

2018-04-01

Adolescence has been referred to as the last best chance to prevent adult non-communicable diseases. Gaining further evidence on the psychosocial determinants of health behaviors, particularly the impact of peers, social networks and media on diet, is necessary to develop appropriate preventive strategies. Based on a multiple-cases study, our aim was to discuss the social influences on adolescents' dietary behavior from a social capital perspective. Participants were reached through four high-schools in different Catalan rural-urban and socioeconomic contexts. Our results confirm the different layout of social capital in the community, school, peers and family. In our sample, family and peers are the most influent sources of social capital in relation to dietary behaviors, inducing both protective and damaging effects. Copyright © 2018 Elsevier Ltd. All rights reserved.

The multi-reference retaining the excitation degree perturbation theory: A size-consistent, unitary invariant, and rapidly convergent wavefunction based ab initio approach

NASA Astrophysics Data System (ADS)

Fink, Reinhold F.

2009-02-01

The retaining the excitation degree (RE) partitioning [R.F. Fink, Chem. Phys. Lett. 428 (2006) 461(20 September)] is reformulated and applied to multi-reference cases with complete active space (CAS) reference wave functions. The generalised van Vleck perturbation theory is employed to set up the perturbation equations. It is demonstrated that this leads to a consistent and well defined theory which fulfils all important criteria of a generally applicable ab initio method: The theory is proven numerically and analytically to be size-consistent and invariant with respect to unitary orbital transformations within the inactive, active and virtual orbital spaces. In contrast to most previously proposed multi-reference perturbation theories the necessary condition for a proper perturbation theory to fulfil the zeroth order perturbation equation is exactly satisfied with the RE partitioning itself without additional projectors on configurational spaces. The theory is applied to several excited states of the benchmark systems CH2 , SiH2 , and NH2 , as well as to the lowest states of the carbon, nitrogen and oxygen atoms. In all cases comparisons are made with full configuration interaction results. The multi-reference (MR)-RE method is shown to provide very rapidly converging perturbation series. Energy differences between states of similar configurations converge even faster.

Pattern Classification of Endocervical Adenocarcinoma: Reproducibility and Review of Criteria

PubMed Central

Rutgers, Joanne K.L.; Roma, Andres; Park, Kay; Zaino, Richard J.; Johnson, Abbey; Alvarado, Isabel; Daya, Dean; Rasty, Golnar; Longacre, Teri; Ronnett, Brigitte; Silva, Elvio

2017-01-01

Previously, our international team proposed a 3-tiered pattern classification (Pattern Classification) system for endocervical adenocarcinoma of the usual type that correlates with nodal disease and recurrence. Pattern Classification- A have well demarcated glands lacking destructive stromal invasion or lymphovascular invasion (lymphovascular invasion), Pattern Classification- B show localized, limited destructive invasion arising from A-type glands, and Pattern Classification- C have diffuse destructive stromal invasion, significant (filling a 4× field) confluence, or solid architecture. 24 Pattern Classification-A, 22 Pattern Classification-B, 38 Pattern Classification-C from the tumor set used in the original description were chosen using the reference diagnosis (reference diagnosis) originally established. 1 H&E slide per case was reviewed by 7 gynecologic pathologists, 4 from the original study. Kappa statistics were prepared, and cases with discrepancies reviewed. We found a majority agreement with reference diagnosis in 81% of cases, with complete or near complete (6 of 7) agreement in 50%. Overall concordance was 74%. Overall Kappa (agreement among pathologists) was .488 (moderate agreement). Pattern Classification- B has lowest kappa, and agreement is not improved by combining B+C. 6 of 7 reviewers had substantial agreement by weighted kappas (>.6), with one reviewer accounting for the majority of cases under or overcalled by 2 tiers. Confluence filling a 4× field, labyrinthine glands, or solid architecture accounted for undercalling other reference diagnosis-C cases. Missing a few individually infiltrative cells was the most common cause of undercalling reference diagnosis- B. Small foci of inflamed, loose or desmoplastic stroma lacking infiltrative tumor cells in reference diagnosis-A appeared to account for those cases up-graded to Pattern Classification-B. In summary, an overall concordance of 74% indicates that the criteria can be reproducibly applied by gynecologic pathologists. Further refinement of criteria should allow use of this powerful classification system to delineate which cervical adenocarcinomas can be safely treated conservatively. PMID:27255163

Efficacy and safety data of subsequent entry biologics pertinent to nephrology practice: a systematic review.

PubMed

Marin, Judith Genevieve; Leung, Marianna; Lo, Clifford; Tsao, Nicole W; Martinusen, Daniel J

2014-01-01

Subsequent entry biologics (SEBs) may soon be a reality in Canadian nephrology practice. Understanding the worldwide experience with these agents will be valuable to Canadian clinicians. To compare the efficacy and safety data between SEBs used in nephrology practice and their reference biologic. Systematic review. Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effects, Cochrane Central Register of Controlled Trials. Adult patients with chronic kidney disease (CKD). Our systematic review follows the process outlined by Cochrane Reviews. For efficacy data, all randomized controlled trials (RCTs), quasi-RCTs and observational trials in nephrology practice were included. For safety data, case series, case reports, review articles in nephrology practice and pharmacovigilance programs were included as well. Only epoetin SEBs trials were published in the literature. Ten studies involving three different epoetin SEBs (epoetin zeta, HX575 and epoetin theta) were included. The mean epoetin dose used did not differ significantly between the SEBs and the reference product. For epoetin zeta and epoetin theta, the mean hemoglobin levels achieved in the studies were similar between the SEBs and the reference epoetin. The HX 575 studies reported a mean absolute change in hemoglobin within the predefined equivalence margin, when compared with the reference biologic. In terms of safety data, 2 cases of pure-red-cell aplasia were linked to the subcutaneous administration of HX 575. Otherwise, the rate of adverse drug reactions was similar when epoetin SEBs were compared with the reference biologic. Our analysis is limited by the paucity of information available on SEB use in nephrology with the exception of epoetin SEBs. Methodological flaw was found in one of the epoetin zeta studies which accounted for 45% of pooled results. Little clinical difference was found between epoetin SEBs and the reference product. Although not deemed clinically important, the financial implication of a possible dose difference between epoetin zeta and reference product should be considered in pharmacoeconomic studies. Ongoing trials are expected to address the risk of pure-red-cell aplasia with HX 575.

The Effects of Case-Based Instruction on Undergraduate Biology Students' Understanding of the Nature of Science

NASA Astrophysics Data System (ADS)

Burniston, Amy Lucinda

Undergraduate science education is currently seeing a dramatic pedagogical push towards teaching the philosophies underpinning science as well as an increase in strategies that employ active learning. Many active learning strategies stem from constructivist ideals and have been shown to affect a student's understanding of how science operates and its impact on society- commonly referred to as the nature of science (NOS). One particular constructivist teaching strategy, case-based instruction (CBI), has been recommended by researchers and science education reformists as an effective instructional strategy for teaching NOS. Furthermore, when coupled with explicit-reflective instruction, CBI has been found to significantly increasing understanding of NOS in elementary and secondary students. However, few studies aimed their research on CBI and NOS towards higher education. Thus, this study uses a quasi-experimental, nonequivalent group design to study the effects of CBI on undergraduate science students understandings of NOS. Undergraduate biology student's understanding of NOS were assessed using the Views of Science Education (VOSE) instrument pre and post CBI intervention in Cellular and Molecular Biology and Human Anatomy and Physiology II. Data analysis indicated statistically significant differences between students NOS scores in experimental versus control sections for both courses, with experimental groups obtaining higher posttest scores. The results of this study indicate that undergraduate male and female students have similarly poor understandings of NOS and the use of historical case based instruction can be used as a means to increase undergraduate understanding of NOS.

Case-control study of low-back pain referred for magnetic resonance imaging, with special focus on whole-body vibration.

PubMed

Palmer, Keith T; Harris, Clare E; Harris, E Claire; Griffin, Michael J; Bennett, James; Reading, Isabel; Sampson, Madelaine; Coggon, David

2008-10-01

This study investigated risk factors for low-back pain among patients referred for magnetic resonance imaging (MRI), with special focus on whole-body vibration. A case-control approach was used. The study population comprised working-aged persons from a catchment area for radiology services. The cases were those in a consecutive series referred for a lumbar MRI because of low-back pain. The controls were age- and gender-matched persons X-rayed for other reasons. Altogether, 252 cases and 820 controls were studied, including 185 professional drivers. The participants were questioned about physical factors loading the spine, psychosocial factors, driving, personal characteristics, mental health, and certain beliefs about low-back pain. Exposure to whole-body vibration was assessed by six measures, including weekly duration of professional driving, hours driven in one period, and current root mean square A(8). Associations with whole-body vibration were examined with adjustment for age, gender, and other potential confounders. Strong associations were found with poor mental health and belief in work as a causal factor for low-back pain, and with occupational sitting for > or =3 hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear-avoidance beliefs, frequent twisting, low decision latitude, and low support at work. However, the associations with the six metrics of whole-body vibration were weak and not statistically significant, and no exposure-response relationships were found. Little evidence of a risk from professional driving or whole-body vibration was found. Drivers were substantially less heavily exposed to whole-body vibration than in some earlier surveys. Nonetheless, it seems that, at the population level, whole-body vibration is not an important cause of low-back pain among those referred for MRI.

Vitamin E Intake and Risk of Renal Cell Carcinoma: A Meta-Analysis of 7 Case-Control Studies.

PubMed

Shang, Yonggang; Yi, Shanhong; Cui, Dong; Han, Guangwei; Liu, Chengcheng

2015-07-01

Vitamin E intake may reduce the risk of renal cell carcinoma, but the results were inconsistent. Hence, we conducted a meta-analysis to assess the association between dietary vitamin E intake and the risk of renal cell carcinoma. We searched PubMed to identify the relevant case-control studies up to June 2014. Reference lists of retrieved articles were also reviewed. Odds ratios and corresponding 95% confidence intervals were used to estimate the association between dietary vitamin E intake and the risk of renal cell carcinoma. We identified 7 case-control studies regarding dietary vitamin E intake and risk of renal cell carcinoma, involving 5789 cases and 14866 controls. The odds ratio of renal cell carcinoma for the highest compared with the lowest dietary vitamin E intake was 0.75 (95% confidence interval: 0.59-0.91), and heterogeneity was observed across studies. The association between dietary vitamin E intake and the risk of renal cell carcinoma was not significantly differed by gender, but this association were inconsistent in the North American and European populations. Our study provided a evidence that there was a significant inverse association of dietary vitamin E intake with risk of renal cell carcinoma. However, this finding was based on the case-control studies, more well-designed cohort studies are needed. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

A case study on the influences of long-range transport to Taiwan`s acid deposition using Taiwan air quality model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ken-Hui Chang; Fu-Tien Jeng

1996-12-31

The long-range and transboundary transport of precursors of add deposition in East Asia became important due to the industrial development around this area. We started to develop Taiwan Air Quality Model (TAQM) system since 1992, which is based on regional Acid Deposition Model (RADM) system. A typical episode in Mei-Yu season has been selected to study. A case considering all emissions within simulated domain has been run as a reference case, and another perturbed case, not including Taiwan`s emission, has been also run for analyzing quantitatively the influence of long-range transport to Taiwan`s wet deposition during the episode are 31%more » and 24% for total sulfur compounds and total nitrogen compounds respectively; but for dry deposition, only 6% is contributed by long range transport for sulfur compounds and 29% for total nitrogen compounds. Therefore, the percentages of total acid deposition contributed by long-range transport are 27% and 25% for total sulfur compounds and total nitrogen compounds, respectively.« less

Explicit area-based accuracy assessment for mangrove tree crown delineation using Geographic Object-Based Image Analysis (GEOBIA)

NASA Astrophysics Data System (ADS)

Kamal, Muhammad; Johansen, Kasper

2017-10-01

Effective mangrove management requires spatially explicit information of mangrove tree crown map as a basis for ecosystem diversity study and health assessment. Accuracy assessment is an integral part of any mapping activities to measure the effectiveness of the classification approach. In geographic object-based image analysis (GEOBIA) the assessment of the geometric accuracy (shape, symmetry and location) of the created image objects from image segmentation is required. In this study we used an explicit area-based accuracy assessment to measure the degree of similarity between the results of the classification and reference data from different aspects, including overall quality (OQ), user's accuracy (UA), producer's accuracy (PA) and overall accuracy (OA). We developed a rule set to delineate the mangrove tree crown using WorldView-2 pan-sharpened image. The reference map was obtained by visual delineation of the mangrove tree crowns boundaries form a very high-spatial resolution aerial photograph (7.5cm pixel size). Ten random points with a 10 m radius circular buffer were created to calculate the area-based accuracy assessment. The resulting circular polygons were used to clip both the classified image objects and reference map for area comparisons. In this case, the area-based accuracy assessment resulted 64% and 68% for the OQ and OA, respectively. The overall quality of the calculation results shows the class-related area accuracy; which is the area of correctly classified as tree crowns was 64% out of the total area of tree crowns. On the other hand, the overall accuracy of 68% was calculated as the percentage of all correctly classified classes (tree crowns and canopy gaps) in comparison to the total class area (an entire image). Overall, the area-based accuracy assessment was simple to implement and easy to interpret. It also shows explicitly the omission and commission error variations of object boundary delineation with colour coded polygons.

Risks of tubo-ovarian abscess in cases of endometrioma and assisted reproductive technologies are both under- and overreported.

PubMed

Villette, Claire; Bourret, Antoine; Santulli, Pietro; Gayet, Vanessa; Chapron, Charles; de Ziegler, Dominique

2016-08-01

To study possible associations among endometriosis, pelvic infectious disease, and ART. Retrospective cohort analysis over 4 consecutive years, based on medical records and insurance coding in a tertiary endometriosis reference center. Tertiary university-based reference center for endometriosis. We retrieved all charts carrying the diagnoses infectious process and endometriosis in 2009-2012. Each chart was individually analyzed for categorization of the infectious episode and determining whether ART had been performed. Hospitalization for acute infection in women with known endometriosis and possible past ART. Retrospective insurance codes-triggered chart analysis. Ten patients were admitted for an acute infection with fever, acute abdomen syndrome, elevated white blood cell count, and adnexal mass. Three women had oocyte retrieval, and an endometrioma was present 16, 57, and 102 days earlier. In one patient, the complication occurred 37 days after a cesarean section without prior ART. In the remaining six cases tubo-ovarian abscesses (TOAs) occurred spontaneously in endometriosis women who never had ART. Medical treatment succeeded in only two patients, and the remaining eight needed laparoscopic drainage. In 6 out of those 8 cases, laparoscopic drainage was a second-stage measure justified by failure to respond to antibiotic therapy. Our data indicate that some putative complications of ART and endometrioma may actually not be linked to ART, but rather constitute sporadic occurrences in endometriosis. Furthermore, TOAs occurring in women with endometriosis are best treated by early surgical drainage together with intravenous antibiotics. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

A case control study: White-collar defendants compared with defendants charged with other nonviolent theft.

PubMed

Poortinga, Ernest; Lemmen, Craig; Jibson, Michael D

2006-01-01

We examined the clinical, criminal, and sociodemographic characteristics of all white-collar crime defendants referred to the evaluation unit of a state center for forensic psychiatry. With 29,310 evaluations in a 12-year period, we found 70 defendants charged with embezzlement, 3 with health care fraud, and no other white-collar defendants (based on the eight crimes widely accepted as white-collar offenses). In a case-control study design, the 70 embezzlement cases were compared with 73 defendants charged with other forms of nonviolent theft. White-collar defendants were found to have a higher likelihood of white race (adjusted odds ratio (adj. OR) = 4.51), more years of education (adj. OR = 3471), and a lower likelihood of substance abuse (adj. OR = .28) than control defendants. Logistic regression modeling showed that the variance in the relationship between unipolar depression and white-collar crime was more economically accounted for by education, race, and substance abuse.

Molecular identification of poisonous mushrooms using nuclear ITS region and peptide toxins: a retrospective study on fatal cases in Thailand.

PubMed

Parnmen, Sittiporn; Sikaphan, Sujitra; Leudang, Siriwan; Boonpratuang, Thitiya; Rangsiruji, Achariya; Naksuwankul, Khwanruan

2016-02-01

Cases of mushroom poisoning in Thailand have increased annually. During 2008 to 2014, the cases reported to the National Institute of Health included 57 deaths; at least 15 died after ingestion of amanitas, the most common lethal wild mushrooms inhabited. Hence, the aims of this study were to identify mushroom samples from nine clinically reported cases during the 7-year study period based on nuclear ITS sequence data and diagnose lethal peptide toxins using a reversed phase LC-MS method. Nucleotide similarity was identified using BLAST search of the NCBI database and the Barcode of Life Database (BOLD). Clade characterization was performed by maximum likelihood and Bayesian phylogenetic approaches. Based on BLAST and BOLD reference databases our results yielded high nucleotide similarities of poisonous mushroom samples to A. exitialis and A. fuliginea. Detailed phylogenetic analyses showed that all mushroom samples fall into their current classification. Detection of the peptide toxins revealed the presence of amatoxins and phallotoxins in A. exitialis and A. fuliginea. In addition, toxic α-amanitin was identified in a new provisional species, Amanita sp.1, with the highest toxin quantity. Molecular identification confirmed that the mushrooms ingested by the patients were members of the lethal amanitas in the sections Amanita and Phalloideae. In Thailand, the presence of A. exitialis was reported here for the first time and all three poisonous mushroom species provided new and informative data for clinical studies.

The Routledge International Companion to Multicultural Education

ERIC Educational Resources Information Center

Banks, James A., Ed.

2010-01-01

This volume is the first authoritative reference work to provide a truly comprehensive international description and analysis of multicultural education around the world. It is organized around "key concepts" and uses "case studies" from various nations in different parts of the world to exemplify and illustrate the concepts. Case studies are from…

The Psychometric Properties of Classroom Response System Data: A Case Study

ERIC Educational Resources Information Center

Kortemeyer, Gerd

2016-01-01

Classroom response systems (often referred to as "clickers") have slowly gained adoption over the recent decade; however, critics frequently doubt their pedagogical value starting with the validity of the gathered responses: There is concern that students simply "click" random answers. This case study looks at different…

Subspecialty surgical pathologist's performances as triage pathologists on a telepathology-enabled quality assurance surgical pathology service: A human factors study

PubMed Central

Braunhut, Beth L.; Graham, Anna R.; Lian, Fangru; Webster, Phyllis D.; Krupinski, Elizabeth A.; Bhattacharyya, Achyut K.; Weinstein, Ronald S.

2014-01-01

Background: The case triage practice workflow model was used to manage incoming cases on a telepathology-enabled surgical pathology quality assurance (QA) service. Maximizing efficiency of workflow and the use of pathologist time requires detailed information on factors that influence telepathologists’ decision-making on a surgical pathology QA service, which was gathered and analyzed in this study. Materials and Methods: Surgical pathology report reviews and telepathology service logs were audited, for 1862 consecutive telepathology QA cases accrued from a single Arizona rural hospital over a 51 month period. Ten university faculty telepathologists served as the case readers. Each telepathologist had an area of subspecialty surgical pathology expertise (i.e. gastrointestinal pathology, dermatopathology, etc.) but functioned largely as a general surgical pathologist while on this telepathology-enabled QA service. They handled all incoming cases during their individual 1-h telepathology sessions, regardless of the nature of the organ systems represented in the real-time incoming stream of outside surgical pathology cases. Results: The 10 participating telepathologists’ postAmerican Board of pathology examination experience ranged from 3 to 36 years. This is a surrogate for age. About 91% of incoming cases were immediately signed out regardless of the subspecialty surgical pathologists’ area of surgical pathology expertise. One hundred and seventy cases (9.13%) were deferred. Case concurrence rates with the provisional surgical pathology diagnosis of the referring pathologist, for incoming cases, averaged 94.3%, but ranged from 88.46% to 100% for individual telepathologists. Telepathology case deferral rates, for second opinions or immunohistochemistry, ranged from 4.79% to 21.26%. Differences in concordance rates and deferral rates among telepathologists, for incoming cases, were significant but did not correlate with years of experience as a practicing pathologist. Coincidental overlaps of the area of subspecialty surgical pathology expertise with organ-related incoming cases did not influence decisions by the telepathologists to either defer those cases or to agree or disagree with the referring pathologist's provisional diagnoses. Conclusions: Subspecialty surgical pathologists effectively served as general surgical pathologists on a telepathology-based surgical pathology QA service. Concurrence rates with incoming surgical pathology report diagnoses, and case deferral rates, varied significantly among the 10 on-service telepathologists. We found no evidence that the higher deferral rates correlated with improving the accuracy or quality of the surgical pathology reports. PMID:25057432

GeneYenta: a phenotype-based rare disease case matching tool based on online dating algorithms for the acceleration of exome interpretation.

PubMed

Gottlieb, Michael M; Arenillas, David J; Maithripala, Savanie; Maurer, Zachary D; Tarailo Graovac, Maja; Armstrong, Linlea; Patel, Millan; van Karnebeek, Clara; Wasserman, Wyeth W

2015-04-01

Advances in next-generation sequencing (NGS) technologies have helped reveal causal variants for genetic diseases. In order to establish causality, it is often necessary to compare genomes of unrelated individuals with similar disease phenotypes to identify common disrupted genes. When working with cases of rare genetic disorders, finding similar individuals can be extremely difficult. We introduce a web tool, GeneYenta, which facilitates the matchmaking process, allowing clinicians to coordinate detailed comparisons for phenotypically similar cases. Importantly, the system is focused on phenotype annotation, with explicit limitations on highly confidential data that create barriers to participation. The procedure for matching of patient phenotypes, inspired by online dating services, uses an ontology-based semantic case matching algorithm with attribute weighting. We evaluate the capacity of the system using a curated reference data set and 19 clinician entered cases comparing four matching algorithms. We find that the inclusion of clinician weights can augment phenotype matching. © 2015 WILEY PERIODICALS, INC.

Plasma 25-hydroxyvitamin D concentration and subsequent risk of total and site specific cancers in Japanese population: large case-cohort study within Japan Public Health Center-based Prospective Study cohort

PubMed Central

Budhathoki, Sanjeev; Hidaka, Akihisa; Sawada, Norie; Tanaka-Mizuno, Sachiko; Kuchiba, Aya; Charvat, Hadrien; Goto, Atsushi; Kojima, Satoshi; Sudo, Natsuki; Shimazu, Taichi; Sasazuki, Shizuka; Inoue, Manami; Tsugane, Shoichiro; Iwasaki, Motoki

2018-01-01

Abstract Objective To evaluate the association between pre-diagnostic circulating vitamin D concentration and the subsequent risk of overall and site specific cancer in a large cohort study. Design Nested case-cohort study within the Japan Public Health Center-based Prospective Study cohort. Setting Nine public health centre areas across Japan. Participants 3301 incident cases of cancer and 4044 randomly selected subcohort participants. Exposure Plasma concentration of 25-hydroxyvitamin D measured by enzyme immunoassay. Participants were divided into quarters based on the sex and season specific distribution of 25-hydroxyvitamin D among subcohorts. Weighted Cox proportional hazard models were used to calculate the multivariable adjusted hazard ratios for overall and site specific cancer across categories of 25-hydroxyvitamin D concentration, with the lowest quarter as the reference. Main outcome measure Incidence of overall or site specific cancer. Results Plasma 25-hydroxyvitamin D concentration was inversely associated with the risk of total cancer, with multivariable adjusted hazard ratios for the second to fourth quarters compared with the lowest quarter of 0.81 (95% confidence interval 0.70 to 0.94), 0.75 (0.65 to 0.87), and 0.78 (0.67 to 0.91), respectively (P for trend=0.001). Among the findings for cancers at specific sites, an inverse association was found for liver cancer, with corresponding hazard ratios of 0.70 (0.44 to 1.13), 0.65 (0.40 to 1.06), and 0.45 (0.26 to 0.79) (P for trend=0.006). A sensitivity analysis showed that alternately removing cases of cancer at one specific site from total cancer cases did not substantially change the overall hazard ratios. Conclusions In this large prospective study, higher vitamin D concentration was associated with lower risk of total cancer. These findings support the hypothesis that vitamin D has protective effects against cancers at many sites. PMID:29514781

A generalized formulation for noise-based seismic velocity change measurements

NASA Astrophysics Data System (ADS)

Gómez-García, C.; Brenguier, F.; Boué, P.; Shapiro, N.; Droznin, D.; Droznina, S.; Senyukov, S.; Gordeev, E.

2017-12-01

The observation of continuous seismic velocity changes is a powerful tool for detecting seasonal variations in crustal structure, volcanic unrest, co- and post-seismic evolution of stress in fault areas or the effects of fluid injection. The standard approach for measuring such velocity changes relies on comparison of travel times in the coda of a set of seismic signals, usually noise-based cross-correlations retrieved at different dates, and a reference trace, usually a averaged function over dates. A good stability in both space and time of the noise sources is then the main assumption for reliable measurements. Unfortunately, these conditions are often not fulfilled, as it happens when ambient-noise sources are non-stationary, such as the emissions of low-frequency volcanic tremors.We propose a generalized formulation for retrieving continuous time series of noise-based seismic velocity changes without any arbitrary reference cross-correlation function. We set up a general framework for future applications of this technique performing synthetic tests. In particular, we study the reliability of the retrieved velocity changes in case of seasonal-type trends, transient effects (similar to those produced as a result of an earthquake or a volcanic eruption) and sudden velocity drops and recoveries as the effects of transient local source emissions. Finally, we apply this approach to a real dataset of noise cross-correlations. We choose the Klyuchevskoy volcanic group (Kamchatka) as a case study where the recorded wavefield is hampered by loss of data and dominated by strongly localized volcanic tremor sources. Despite the mentioned wavefield contaminations, we retrieve clear seismic velocity drops associated with the eruptions of the Klyuchevskoy an the Tolbachik volcanoes in 2010 and 2012, respectively.

The Transformation of Ergonomic Affordances into Cultural Affordances: The Case of the Alnuset System

ERIC Educational Resources Information Center

Chiappini, Giampaolo

2012-01-01

Is it possible to study the ergonomic affordances offered by a system designed for educational aims and their transformation into cultural affordances? To this purpose, what references can we adopt? This work describes the theoretical framework used to realise this study referring to AlNuSet, a system realised within the EC ReMath project to…

Trace element reference values in tissues from inhabitants of the EU. XII. Development of BioReVa program for statistical treatment.

PubMed

Iversen, B S; Sabbioni, E; Fortaner, S; Pietra, R; Nicolotti, A

2003-01-20

Statistical data treatment is a key point in the assessment of trace element reference values being the conclusive stage of a comprehensive and organized evaluation process of metal concentration in human body fluids. The EURO TERVIHT project (Trace Elements Reference Values in Human Tissues) was started for evaluating, checking and suggesting harmonized procedures for the establishment of trace element reference intervals in body fluids and tissues. Unfortunately, different statistical approaches are being used in this research field making data comparison difficult and in some cases impossible. Although international organizations such as International Federation of Clinical Chemistry (IFCC) or International Union of Pure and Applied Chemistry (IUPAC) have issued recommended guidelines for reference values assessment, including the statistical data treatment, a unique format and a standardized data layout is still missing. The aim of the present study is to present a software (BioReVa) running under Microsoft Windows platform suitable for calculating the reference intervals of trace elements in body matrices. The main scope for creating an ease-of-use application was to control the data distribution, to establish the reference intervals according to the accepted recommendation, on the base of the simple statistic, to get a standard presentation of experimental data and to have an application to which further need could be integrated in future. BioReVa calculates the IFCC reference intervals as well as the coverage intervals recommended by IUPAC as a supplement to the IFCC intervals. Examples of reference values and reference intervals calculated with BioReVa software concern Pb and Se in blood; Cd, In and Cr in urine, Hg and Mo in hair of different general European populations. University of Michigan

SU-F-P-40: Analysis of Pelvic Lymph Node Margin Using Prostate Fiducial Markers, for SBRT Treatments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Torres, J; Castro Pena, P; Garrigo, E

2016-06-15

Purpose: The use of fiducials markers in prostate treatment allows a precise localization of this volume. Typical prostate SBRT margins with fiducials markers are 5mm in all directions, except toward the rectum, where 3mm is used. For some patients nearby pelvic lymph nodes with 5mm margin need to be irradiate assuming that its localization is linked to the prostate fiducial markers instead of bony anatomy. The purpose of this work was to analyze the geometric impact of locate the lymph node regions through the patient positioning by prostate fiducial markers. Methods: 10 patients with prostate SBRT with lymph nodes irradiationmore » were selected. Each patient had 5 implanted titanium fiducial markers. A Novalis TX (BrainLAB-Varian) with ExacTrac and aSi1000 portal image was used. Treatment plan uses 11 beams with a dose prescription (D95%) of 40Gy to the prostate and 25Gy to the lymph node in 5 fractions. Daily positioning was carried out by ExacTrac system based on the implanted fiducials as the reference treatment position; further position verification was performed using the ExacTrac and two portal images (gantry angle 0 and 90) based on bony structures. Comparison between reference position with bony based ExacTrac and portal image localization, was done for each treatment fraction Results: A total of 50 positioning analysis were done. The average discrepancy between reference treatment position and ExacTrac based on bony anatomy (pubic area) was 4.2mm [0.3; 11.2]. The discrepancy was <5mm in 61% of the cases and <9mm in 92%. Using portal images the average discrepancy was 3.7mm [0.0; 11.1]. The discrepancy was <5mm in 69% of the cases and <9mm in 96%. Conclusion: Localizing lymph node by prostate fiducial markers may produce large discrepancy as large as 11mm compared to bony based localization. Dosimetric impact of this discrepancy should be studied.« less

High-risk CTV delineation for cervix brachytherapy: Application of GEC-ESTRO guidelines in Australia and New Zealand.

PubMed

Vinod, Shalini K; Lim, Karen; Bell, Lauren; Veera, Jacqueline; Ohanessian, Lucy; Juresic, Ewa; Borok, Nira; Chan, Phillip; Chee, Raphael; Do, Viet; Govindarajulu, Geetha; Sridharan, Swetha; Johnson, Carol; Moses, Daniel; Van Dyk, Sylvia; Holloway, Lois

2017-02-01

Image-based brachytherapy for cervical cancer using MRI has been implemented in Australia and New Zealand. The aims of this study were to measure variability in High-risk CTV (HR-CTV) delineation and evaluate dosimetric consequences of this. Nine radiation oncologists, one radiation therapist and two radiologists contoured HR-CTV on 3T MRI datasets from ten consecutive patients undergoing cervical brachytherapy at a single institution. Contour comparisons were performed using the Dice Similarity Coefficient (DSC) and Mean Absolute Surface Distance (MASD). Two reference contours were created for brachytherapy planning: a Simultaneous Truth and Performance Level Estimation (STAPLE) and a consensus contour (CONSENSUS). Optimized plans (8 Gy) for both these contours were applied to individual participant's contours to assess D90 and D100 coverage of HR CTV. To compare variability in dosimetry, relative standard deviation (rSD) was calculated. Good concordance (mean DSC≥0.7, MASD≤5 mm) was achieved in 8/10 cases when compared to the STAPLE reference and 6/10 cases when compared to the CONSENSUS reference. Greatest variation was visually seen in the cranio-caudal direction. The average mean rSD across all patients was 27% and 34% for the STAPLE HR-CTV D90 and D100, respectively, and 28% and 35% for the CONSENSUS HR-CTV D90 and D100. Delineation uncertainty resulted in an average dosimetric uncertainty of ±1.5-1.6 Gy per fraction based on an 8 Gy prescribed fraction. Delineation of HR-CTV for cervical cancer brachytherapy was consistent amongst observers, suggesting similar interpretation of GEC-ESTRO guidelines. Despite the good concordance, there was dosimetric variation noted, which could be clinically significant. © 2016 The Royal Australian and New Zealand College of Radiologists.

Eosinophilic esophageal myositis diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report.

PubMed

Igarashi, Ryo; Irisawa, Atsushi; Shibukawa, Goro; Yamabe, Akane; Fujisawa, Mariko; Sato, Ai; Maki, Takumi; Arakawa, Noriyuki; Yoshida, Yoshitsugu; Yamamoto, Shogo; Ikeda, Tsunehiko

2016-10-01

Eosinophilic esophagitis (EoE) is diagnosed by microscopic findings of eosinophilic infiltration into the squamous epithelium. In contrast, another disease concept termed "eosinophilic esophageal myositis (EoEM)" has been proposed, whereby there is eosinophilic infiltration into the muscularis propria instead. A 60-year-old man was referred to our hospital for chest pain, dysphagia, and several episodes of esophageal food impaction. Although EoE was suspected based on clinical features, biopsy specimens showed no mucosal eosinophilic infiltration. Endoscopic ultrasound (EUS) showed thickening of the muscularis propria layer and subsequent EUS-guided fine-needle aspiration biopsy (EUS-FNA) revealed eosinophilic infiltration into the muscularis propria. Although the patient's symptoms gradually improved after steroid administration, complete remission was not achieved after 1 year of treatment. This case may reflect a disorder distinct from typical EoE based on eosinophilic infiltration of the muscularis propria but not the squamous epithelium, and we, therefore, diagnosed it as EoEM using the EUS-FNA findings as reference.

Serological diagnosis of Toxoplasma gondii infection: Recommendations from the French National Reference Center for Toxoplasmosis.

PubMed

Villard, O; Cimon, B; L'Ollivier, C; Fricker-Hidalgo, H; Godineau, N; Houze, S; Paris, L; Pelloux, H; Villena, I; Candolfi, E

2016-01-01

Toxoplasmosis manifests no clinical signs in 80% of cases in immunocompetent patient, causing immunization characterized by the persistence of cysts, particularly in brain, muscles, and retina. Assessing the serological status, based on testing for serum toxoplasma IgG and IgM antibodies, is essential in cases that are increasingly at risk for the more severe disease forms, such as congenital or ocular toxoplasmosis. This disease also exposes immunosuppressed patients to reactivation, which can lead to more widespread forms and increased mortality. By interpreting the serological results, we can estimate the risk of contamination or reactivation and define appropriate prophylactic and preventive measures, such as hygienic and dietetic, therapeutic, biological, and clinical follow-up, according to the clinical context. We hereby propose practical approaches based on serological data, resulting from a consensus of a group of experts from the French National Reference Center Network for Toxoplasmosis, according to both routine and specific clinical situations. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

[Case mix analysis of patients who can be referred from emergency department triage to primary care].

PubMed

Gómez-Jiménez, Josep; Becerra, Oscar; Boneu, Francisco; Burgués, Lluís; Pàmies, Salvador

2006-01-01

Structured emergency department (ED) triage scales can be used to develop patient referral strategies from the ED to primary care. The objectives of the present study were to evaluate the percentage of patients who could potentially be referred from triage to primary care and to describe their clinical characteristics. We analyzed all patients with low acuity (triage levels IV and V) and low complexity (patients discharged from the ED) triaged during 2003 with the Andorran Triage Model in the ED and estimated the percentage of patients who could potentially be referred on the basis of three primary care models: A, centers unable to deal with emergencies or perform complementary investigations; B, centers able to deal with emergencies and perform complementary investigations, and C, centers able to deal with emergencies but unable to perform complementary investigations. Of the 25,319 patients included in the study, 5.63% could be referred to model A, 75.22% to model B and 33.36% to model C. A total of 81.04% of these model C patients were classified in seven symptomatic categories: wounds and traumatisms, inflammation or fever, pediatric problems, rhinolaryngological infection or alterations, ocular symptoms, pain and cutaneous allergy or reactions. Casemix analysis, based on the level of acuity and discharge criteria, can be used to establish the percentage of patients that could potentially be referred to primary care. Analysis of their clinical profile is useful to design referral protocols.

A reference model for model-based design of critical infrastructure protection systems

NASA Astrophysics Data System (ADS)

Shin, Young Don; Park, Cheol Young; Lee, Jae-Chon

2015-05-01

Today's war field environment is getting versatile as the activities of unconventional wars such as terrorist attacks and cyber-attacks have noticeably increased lately. The damage caused by such unconventional wars has also turned out to be serious particularly if targets are critical infrastructures that are constructed in support of banking and finance, transportation, power, information and communication, government, and so on. The critical infrastructures are usually interconnected to each other and thus are very vulnerable to attack. As such, to ensure the security of critical infrastructures is very important and thus the concept of critical infrastructure protection (CIP) has come. The program to realize the CIP at national level becomes the form of statute in each country. On the other hand, it is also needed to protect each individual critical infrastructure. The objective of this paper is to study on an effort to do so, which can be called the CIP system (CIPS). There could be a variety of ways to design CIPS's. Instead of considering the design of each individual CIPS, a reference model-based approach is taken in this paper. The reference model represents the design of all the CIPS's that have many design elements in common. In addition, the development of the reference model is also carried out using a variety of model diagrams. The modeling language used therein is the systems modeling language (SysML), which was developed and is managed by Object Management Group (OMG) and a de facto standard. Using SysML, the structure and operational concept of the reference model are designed to fulfil the goal of CIPS's, resulting in the block definition and activity diagrams. As a case study, the operational scenario of the nuclear power plant while being attacked by terrorists is studied using the reference model. The effectiveness of the results is also analyzed using multiple analysis models. It is thus expected that the approach taken here has some merits over the traditional design methodology of repeating requirements analysis and system design.

Direct toxicity assessment - Methods, evaluation, interpretation.

PubMed

Gruiz, Katalin; Fekete-Kertész, Ildikó; Kunglné-Nagy, Zsuzsanna; Hajdu, Csilla; Feigl, Viktória; Vaszita, Emese; Molnár, Mónika

2016-09-01

Direct toxicity assessment (DTA) results provide the scale of the actual adverse effect of contaminated environmental samples. DTA results are used in environmental risk management of contaminated water, soil and waste, without explicitly translating the results into chemical concentration. The end points are the same as in environmental toxicology in general, i.e. inhibition rate, decrease in the growth rate or in yield and the 'no effect' or the 'lowest effect' measurement points of the sample dilution-response curve. The measurement unit cannot be a concentration, since the contaminants and their content in the sample is unknown. Thus toxicity is expressed as the sample proportion causing a certain scale of inhibition or no inhibition. Another option for characterizing the scale of toxicity of an environmental sample is equivalencing. Toxicity equivalencing represents an interpretation tool which enables toxicity of unknown mixtures of chemicals be converted into the concentration of an equivalently toxic reference substance. Toxicity equivalencing, (i.e. expressing the toxicity of unknown contaminants as the concentration of the reference) makes DTA results better understandable for non-ecotoxicologists and other professionals educated and thinking based on the chemical model. This paper describes and discusses the role, the principles, the methodology and the interpretation of direct toxicity assessment (DTA) with the aim to contribute to the understanding of the necessity to integrate DTA results into environmental management of contaminated soil and water. The paper also introduces the benefits of the toxicity equivalency method. The use of DTA is illustrated through two case studies. The first case study focuses on DTA of treated wastewater with the aim to characterize the treatment efficacy of a biological wastewater treatment plant by frequent bioassaying. The second case study applied DTA to investigate the cover layers of two bauxite residue (red mud) reservoirs. Based on the DTA results the necessary toxicity attenuation rate of the cover layers was estimated. Copyright © 2016 Elsevier B.V. All rights reserved.

A vertebrate case study of the quality of assemblies derived from next-generation sequences

PubMed Central

2011-01-01

The unparalleled efficiency of next-generation sequencing (NGS) has prompted widespread adoption, but significant problems remain in the use of NGS data for whole genome assembly. We explore the advantages and disadvantages of chicken genome assemblies generated using a variety of sequencing and assembly methodologies. NGS assemblies are equivalent in some ways to a Sanger-based assembly yet deficient in others. Nonetheless, these assemblies are sufficient for the identification of the majority of genes and can reveal novel sequences when compared to existing assembly references. PMID:21453517

Comparing distinct ground-based lightning location networks covering the Netherlands

NASA Astrophysics Data System (ADS)

de Vos, Lotte; Leijnse, Hidde; Schmeits, Maurice; Beekhuis, Hans; Poelman, Dieter; Evers, Läslo; Smets, Pieter

2015-04-01

Lightning can be detected using a ground-based sensor network. The Royal Netherlands Meteorological Institute (KNMI) monitors lightning activity in the Netherlands with the so-called FLITS-system; a network combining SAFIR-type sensors. This makes use of Very High Frequency (VHF) as well as Low Frequency (LF) sensors. KNMI has recently decided to replace FLITS by data from a sub-continental network operated by Météorage which makes use of LF sensors only (KNMI Lightning Detection Network, or KLDN). KLDN is compared to the FLITS system, as well as Met Office's long-range Arrival Time Difference (ATDnet), which measures Very Low Frequency (VLF). Special focus lies on the ability to detect Cloud to Ground (CG) and Cloud to Cloud (CC) lightning in the Netherlands. Relative detection efficiency of individual flashes and lightning activity in a more general sense are calculated over a period of almost 5 years. Additionally, the detection efficiency of each system is compared to a ground-truth that is constructed from flashes that are detected by both of the other datasets. Finally, infrasound data is used as a fourth lightning data source for several case studies. Relative performance is found to vary strongly with location and time. As expected, it is found that FLITS detects significantly more CC lightning (because of the strong aptitude of VHF antennas to detect CC), though KLDN and ATDnet detect more CG lightning. We analyze statistics computed over the entire 5-year period, where we look at CG as well as total lightning (CC and CG combined). Statistics that are considered are the Probability of Detection (POD) and the so-called Lightning Activity Detection (LAD). POD is defined as the percentage of reference flashes the system detects compared to the total detections in the reference. LAD is defined as the fraction of system recordings of one or more flashes in predefined area boxes over a certain time period given the fact that the reference detects at least one flash, compared to the total recordings in the reference dataset. The reference for these statistics is taken to be either another dataset, or a dataset consisting of flashes detected by two datasets. Extreme thunderstorm case evaluation shows that the weather alert criterion for severe thunderstorm is reached by FLITS when this is not the case in KLDN and ATD, suggesting the need for KNMI to modify that weather alert criterion when using KLDN.

The epidemiology of injury in hang-gliding and paragliding.

PubMed

Rekand, Tiina

2012-01-01

Para- and hang-gliding are modern air sports that developed in the 20th century. Performers should possess technical skills and manage certified equipment for successful flight. Injuries may happen during the take-off, flight and landing. PubMed was searched using the search terms 'paragliding' and/or 'hang-gliding'. The reference lists of articles identified in the search strategy were also searched for relevant articles. The most common injuries are fractures, dislocations or sprains in the extremities, followed by spinal and head traumas. Multiple injuries after accidents are common. Collision with electrical wires may cause burn injuries. Fatal outcomes are caused by brain injuries, spinal cord injuries at the cervical level or aorta rupture. Accidents happen because of risk-taking behavior, lack of education or use of self-modified equipment. Observational studies have suggested the need for protection of the head, trunk and lower extremities. The measures proposed are often based on conclusions of observational studies and not proven through randomized studies. Better education along with focusing on possible risk factors will probably diminish the risks of hang- and paragliding. Large denominator-based case series, case-control and population-based studies are needed for assessment of the risks of hang- and paragliding. Copyright © 2012 S. Karger AG, Basel.

The 27-28 October 1986 FIRE Cirrus case study - Retrieval of cloud particle sizes and optical depths from comparative analyses of aircraft and satellite-based infrared measurements

NASA Technical Reports Server (NTRS)

Hammer, Philip D.; Valero, Francisco P. J.; Kinne, Stefan

1991-01-01

Infrared radiance measurements were acquired from a narrow-field nadir-viewing radiometer based on the NASA ER-2 aircraft during a coincident Landsat 5 overpass on October 28, 1986 as part of the FIRE Cirrus IFO in the vicinity of Lake Michigan. The spectral bandpasses are 9.90-10.87 microns for the ER-2-based radiometer and 10.40-12.50 microns for the Landsat thematic mapper band. After adjusting for spatial and temporal differences, a comparative study using data from these two instruments is undertaken in order to retrieve cirrus cloud ice-crystal sizes and optical depths. Retrieval is achieved by analysis of measurement correlations between the two spectral bands and comparison to multistream radiative transfer model calculations. The results indicate that the equivalent sphere radii of the cirrus ice crystals were typically less than 30 microns. Such particles were too small to be measured by the available in situ instrumentation. Cloud optical depths at a reference wavelength of 11.4 microns ranged from 0.3 to 2.0 for this case study. Supplemental results in support of this study are described using radiation measurements from the King Air aircraft, which was also in near coincidence with the Landsat overpass.

Arterial Pressure Variation in Elective Non-cardiac Surgery: Identifying Reference Distributions and Modifying Factors

PubMed Central

Mathis, Michael R.; Schechtman, Samuel A.; Engoren, Milo C.; Shanks, Amy M.; Thompson, Aleda; Kheterpal, Sachin; Tremper, Kevin K.

2016-01-01

Background Assessment of need for intravascular volume resuscitation remains challenging for anesthesiologists. Dynamic waveform indices, including systolic- and pulse-pressure variation (SPV/PPV), are demonstrated as reliable measures of fluid-responsiveness for mechanically ventilated patients. Despite widespread use, real-world reference distributions for SPV and PPV values have not been established for euvolemic intraoperative patients. The authors sought to establish SPV and PPV reference distributions and assess impact of modifying factors. Methods The authors evaluated adult patients undergoing general anesthetics for elective non-cardiac surgery. Median SPV and PPV over a 50-minute post-induction period were noted for each case. Modifying factors including body-mass index, age, ventilator settings, positioning, and hemodynamic management were studied via univariate and multivariable analyses. For SPV values, effects of data entry method (manually-entered versus automated recorded) were similarly studied. Results Among 1,791 cases, per-case median SPV and PPV values formed non-parametric distributions. For each distribution, median values, interquartile ranges, and reference intervals (2.5th-97.5th percentile) were respectively noted: these included manually-entered SPV (6.0, 5.0-7.0, 3.0-11.0 mmHg), automated SPV (4.7, 3.9-6.0, 2.2-10.4 mmHg), and automated PPV (7.0, 5.0-9.0, 2.0-16.0%). Non-supine positioning and preoperative beta blocker were independently associated with altered SPV and PPV, whereas ventilator tidal volume >8 mL/kg ideal body weight and peak inspiratory pressure >16 cm H2O demonstrated independent associations for SPV only. Conclusions This study establishes real-world SPV and PPV reference distributions absent in the current literature. Through a consideration of reference distributions and modifying factors, our study provides further evidence for assessing intraoperative volume status and fluid management therapies. PMID:27906705

Novel H+-Ion Sensor Based on a Gated Lateral BJT Pair

PubMed Central

Yuan, Heng; Zhang, Jixing; Cao, Chuangui; Zhang, Gangyuan; Zhang, Shaoda

2015-01-01

An H+-ion sensor based on a gated lateral bipolar junction transistor (BJT) pair that can operate without the classical reference electrode is proposed. The device is a special type of ion-sensitive field-effect transistor (ISFET). Classical ISFETs have the advantage of miniaturization, but  they are difficult to fabricate by a single fabrication process because of the bulky and brittle reference electrode materials. Moreover, the reference electrodes need to be separated from the sensor device in some cases. The proposed device is composed of two gated lateral BJT components, one of which had a silicide layer while the other was without the layer. The two components were operated under the metal-oxide semiconductor field-effect transistor (MOSFET)-BJT hybrid mode, which can be controlled by emitter voltage and base current. Buffer solutions with different pH values were used as the sensing targets to verify the characteristics of the proposed device. Owing to their different sensitivities, both components could simultaneously detect the H+-ion concentration and function as a reference to each other. Per the experimental results, the sensitivity of the proposed device was found to be approximately 0.175 μA/pH. This experiment demonstrates enormous potential to lower the cost of the ISFET-based sensor technology. PMID:26703625

Manual therapy in the management of a patient with a symptomatic Morton's Neuroma: A case report.

PubMed

Sault, Josiah D; Morris, Matthew V; Jayaseelan, Dhinu J; Emerson-Kavchak, Alicia J

2016-02-01

Patients with Morton's neuroma are rarely referred to physical therapy. This case reports the resolution of pain, increase in local pressure pain thresholds, and improvement of scores on the Lower Extremity Functional Scale and Foot and Ankle Ability Measure following a course of joint based manual therapy for a patient who had failed standard conservative medical treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Defining datasets and creating data dictionaries for quality improvement and research in chronic disease using routinely collected data: an ontology-driven approach.

PubMed

de Lusignan, Simon; Liaw, Siaw-Teng; Michalakidis, Georgios; Jones, Simon

2011-01-01

The burden of chronic disease is increasing, and research and quality improvement will be less effective if case finding strategies are suboptimal. To describe an ontology-driven approach to case finding in chronic disease and how this approach can be used to create a data dictionary and make the codes used in case finding transparent. A five-step process: (1) identifying a reference coding system or terminology; (2) using an ontology-driven approach to identify cases; (3) developing metadata that can be used to identify the extracted data; (4) mapping the extracted data to the reference terminology; and (5) creating the data dictionary. Hypertension is presented as an exemplar. A patient with hypertension can be represented by a range of codes including diagnostic, history and administrative. Metadata can link the coding system and data extraction queries to the correct data mapping and translation tool, which then maps it to the equivalent code in the reference terminology. The code extracted, the term, its domain and subdomain, and the name of the data extraction query can then be automatically grouped and published online as a readily searchable data dictionary. An exemplar online is: www.clininf.eu/qickd-data-dictionary.html Adopting an ontology-driven approach to case finding could improve the quality of disease registers and of research based on routine data. It would offer considerable advantages over using limited datasets to define cases. This approach should be considered by those involved in research and quality improvement projects which utilise routine data.

Strengthening your ties to referring physicians through RIS/PACS integration.

PubMed

Worthy, Susan; Rounds, Karla C; Soloway, Connie B

2003-01-01

Many imaging centers are turning to technology solutions to increase refering physician satisfaction, implementing such enhancements as automated report distribution, picture archiving and communications system (PACS), radiology information systems (RIS), and web-based results access. However, without seamless integration, these technology investments don't address the challenge at its core: convenient and reliable, two-way communication and interaction with referring physicians. In an integrated RIS/PACS solution, patient tracking in the RIS and PACS study status are logged and available to users. The time of the patient's registration at the imaging center, the exam start and completion time, the patient's departure time from the imaging center, and results status are all tracked and logged. An integrated RIS/PACS solution provides additional support to the radiologist, a critical factor that can improve the turnaround time of results to referring physicians. The RIS/PACS enhances the interpretation by providing the patient's history, which gives the radiologist additional insight and decreases the likelihood of missing a diagnostic element. In a tightly integrated RIS/PACS solution, results information is more complete. Physicians can view reports with associated images selected by the radiologist. They will also have full order information and complete imaging history including prior reports and images. Referring physicians can access and view images and exam notes at the same time that the radiologist is interpreting the exam. Without the benefit of an integrated RIS/PACS system, the referring physician would have to wait for the signed transcription to be released. In a seamlessly integrated solution, film-tracking modules within the RIS are fused with digital imaging workflow in the PACS. Users can see at a glance if a historical exam is available on film and benefit when a complete study history--both film-based and digital--is presented with the current case. It is up to the imaging center to market the benefits of reduced errors, reduced turnaround times, and a higher level of service to referring physician community, and encourage them to take advantage of the convenience it provides. The savvy imaging center will also regard the integrated RIS/PACS as a valuable marketing tool for use in attracting radiologists.

Resilience in Utility Technologies

NASA Astrophysics Data System (ADS)

Seaton, Roger

The following sections are included: * Scope of paper * Preamble * Background to the case-study projects * Source projects * Resilience * Case study 1: Electricity generation * Context * Model * Case study 2: Water recycling * Context * Model * Case study 3: Ecotechnology and water treatment * Context * The problem of classification: Finding a classificatory solution * Application of the new taxonomy to water treatment * Concluding comments and questions * Conclusions * Questions and issues * Purposive or Purposeful? * Resilience: Flexibility and adaptivity? * Resilience: With respect of what? * Risk, uncertainty, surprise, emergence - What sort of shock, and who says so? * Co-evolutionary friction * References

A clinical registry of dementia based on the principle of epidemiological surveillance

PubMed Central

Garre-Olmo, Josep; Flaqué, Margarita; Gich, Jordi; Pulido, Teresa Osuna; Turbau, Josefina; Vallmajo, Natalia; Viñas, Marta; López-Pousa, Secundí

2009-01-01

Background Traditional epidemiological studies do not allow elucidating the reality of referral and diagnosis patterns of dementia in routine clinical practice within a defined territory. This information is useful and necessary in order to plan and allocate healthcare resources. This paper presents the results from a dementia case registry based on epidemiological surveillance fundamentals. Methods Standardised registry of dementia diagnoses made in 2007 by specialised care centres in the Health Region of Girona (RSG) (Spain), which encompasses an area of 5,517 sq. km and a reference population of 690,207 inhabitants. Results 577 cases of dementia were registered, of which 60.7% corresponded to cases of Alzheimer's disease. Presenile dementia accounted for 9.3% of the cases. Mean time between the onset of symptoms and clinical diagnosis was 2.4 years and the severity of the dementia was mild in 60.7% of the cases. High blood pressure, a family history of dementia, dislipidemia, and a past history of depression were the most common conditions prior to the onset of the disease (>20%). Conclusion The ReDeGi is a viable epidemiological surveillance device that provides information about the clinical and demographic characteristics of patients diagnosed with dementia in a defined geographical area. PMID:19175921

Reference-tissue correction of T2-weighted signal intensity for prostate cancer detection

NASA Astrophysics Data System (ADS)

Peng, Yahui; Jiang, Yulei; Oto, Aytekin

2014-03-01

The purpose of this study was to investigate whether correction with respect to reference tissue of T2-weighted MRimage signal intensity (SI) improves its effectiveness for classification of regions of interest (ROIs) as prostate cancer (PCa) or normal prostatic tissue. Two image datasets collected retrospectively were used in this study: 71 cases acquired with GE scanners (dataset A), and 59 cases acquired with Philips scanners (dataset B). Through a consensus histology- MR correlation review, 175 PCa and 108 normal-tissue ROIs were identified and drawn manually. Reference-tissue ROIs were selected in each case from the levator ani muscle, urinary bladder, and pubic bone. T2-weighted image SI was corrected as the ratio of the average T2-weighted image SI within an ROI to that of a reference-tissue ROI. Area under the receiver operating characteristic curve (AUC) was used to evaluate the effectiveness of T2-weighted image SIs for differentiation of PCa from normal-tissue ROIs. AUC (+/- standard error) for uncorrected T2-weighted image SIs was 0.78+/-0.04 (datasets A) and 0.65+/-0.05 (datasets B). AUC for corrected T2-weighted image SIs with respect to muscle, bladder, and bone reference was 0.77+/-0.04 (p=1.0), 0.77+/-0.04 (p=1.0), and 0.75+/-0.04 (p=0.8), respectively, for dataset A; and 0.81+/-0.04 (p=0.002), 0.78+/-0.04 (p<0.001), and 0.79+/-0.04 (p<0.001), respectively, for dataset B. Correction in reference to the levator ani muscle yielded the most consistent results between GE and Phillips images. Correction of T2-weighted image SI in reference to three types of extra-prostatic tissue can improve its effectiveness for differentiation of PCa from normal-tissue ROIs, and correction in reference to the levator ani muscle produces consistent T2-weighted image SIs between GE and Phillips MR images.

Case Studies on Technical and Vocational Education in Asia and the Pacific. Report of Regional Meeting (Kuala Lumpur, Malaysia, December 12-15, 1994). Exemplar Curriculum Project Working Group Report.

ERIC Educational Resources Information Center

Haas, Adrian, Ed.

This conference report provides summaries of presentations of country case studies from a project to investigate factors that impinged upon the status of technical and vocational education (TVE) in Asian and Pacific countries. The report includes the case study project terms of reference, a list of delegates, and agenda. Summaries follow of the…

Systematic review and meta-analysis of the economic impact of smoking bans in restaurants and bars.

PubMed

Cornelsen, Laura; McGowan, Yvonne; Currie-Murphy, Laura M; Normand, Charles

2014-05-01

To review systematically the literature on the economic impact of smoking bans in bars and restaurants and provide an estimate of the impact size using meta-analysis. Studies were identified by systematic database searches and screening references of reviews and relevant studies. Google and web-pages of tobacco control agencies were also searched. The review identified 56 studies using absolute sales, sales ratio or employment data and employing regression methods to evaluate the impact of smoking bans in the United States, Australia or in countries in South America or Europe. The meta-analysis included 39 comparable studies, with 129 cases identified based on the outcome measure, scope of the ban, type of establishment and geographical location. Methodological quality was assessed based on four pre-determined criteria. Study and case selection and data extraction were conducted independently by two researchers. Random-effects meta-analysis of all cases showed no associations between smoking bans and changes in absolute sales or employment. An increase in the share of bar and restaurant sector sales in total retail sales was associated with smoking bans [0.23 percentage-points; 95% confidence interval (CI) 0.08-0.375]. When cases were separated by business type (bars or restaurants or wider hospitality including bars and restaurants), some differential impacts emerged. Meta-analysis of the economic impact of smoking bans in hospitality sector showed overall no substantial economic gains or losses. Differential impacts were observed across individual business types and outcome variable, but at aggregate level these appear to balance out. © 2014 Society for the Study of Addiction.

Annual energy outlook 1998 : with projections to 2020

DOT National Transportation Integrated Search

1997-12-01

The analysis in AEO98 focuses primarily on a reference case and four other cases that assume higher and lower economic growth and higher and lower world oil prices than in the reference case. Forecast tables for these cases are provided in Appendixes...

Atlas-guided prostate intensity modulated radiation therapy (IMRT) planning.

PubMed

Sheng, Yang; Li, Taoran; Zhang, You; Lee, W Robert; Yin, Fang-Fang; Ge, Yaorong; Wu, Q Jackie

2015-09-21

An atlas-based IMRT planning technique for prostate cancer was developed and evaluated. A multi-dose atlas was built based on the anatomy patterns of the patients, more specifically, the percent distance to the prostate and the concaveness angle formed by the seminal vesicles relative to the anterior-posterior axis. A 70-case dataset was classified using a k-medoids clustering analysis to recognize anatomy pattern variations in the dataset. The best classification, defined by the number of classes or medoids, was determined by the largest value of the average silhouette width. Reference plans from each class formed a multi-dose atlas. The atlas-guided planning (AGP) technique started with matching the new case anatomy pattern to one of the reference cases in the atlas; then a deformable registration between the atlas and new case anatomies transferred the dose from the atlas to the new case to guide inverse planning with full automation. 20 additional clinical cases were re-planned to evaluate the AGP technique. Dosimetric properties between AGP and clinical plans were evaluated. The classification analysis determined that the 5-case atlas would best represent anatomy patterns for the patient cohort. AGP took approximately 1 min on average (corresponding to 70 iterations of optimization) for all cases. When dosimetric parameters were compared, the differences between AGP and clinical plans were less than 3.5%, albeit some statistical significances observed: homogeneity index (p  >  0.05), conformity index (p  <  0.01), bladder gEUD (p  <  0.01), and rectum gEUD (p  =  0.02). Atlas-guided treatment planning is feasible and efficient. Atlas predicted dose can effectively guide the optimizer to achieve plan quality comparable to that of clinical plans.

Electronic-projecting Moire method applying CBR-technology

NASA Astrophysics Data System (ADS)

Kuzyakov, O. N.; Lapteva, U. V.; Andreeva, M. A.

2018-01-01

Electronic-projecting method based on Moire effect for examining surface topology is suggested. Conditions of forming Moire fringes and their parameters’ dependence on reference parameters of object and virtual grids are analyzed. Control system structure and decision-making subsystem are elaborated. Subsystem execution includes CBR-technology, based on applying case base. The approach related to analysing and forming decision for each separate local area with consequent formation of common topology map is applied.

Case Studies: Persecution/Genocide. The Human Rights Series. Volume III.

ERIC Educational Resources Information Center

Litynsky, Walter; And Others

A continuation of the study of those factors that lead to persecutions and acts of genocide is presented. As students read the materials included in the case studies, they should be referred to the organizing concepts discussed in "Teaching about the Holocaust and Genocide: Introduction. The Human Rights Series, Volume I." Unit 1 in that…

Operation Team Spirit: Program Review and Analysis

DTIC Science & Technology

2009-06-01

research was strictly qualitative in nature. The specific method being used was exploratory case study analysis... study , method is used for the specific acts of conducting research , while methodology refers to the qualitative nature of research performed. While...the researcher . According to Leedy and Ormrod (2005), some of the types of methods and their respective purposes include: • Case study :

The Knowledge Base as an Extension of Distance Learning Reference Service

ERIC Educational Resources Information Center

Casey, Anne Marie

2012-01-01

This study explores knowledge bases as extension of reference services for distance learners. Through a survey and follow-up interviews with distance learning librarians, this paper discusses their interest in creating and maintaining a knowledge base as a resource for reference services to distance learners. It also investigates their perceptions…

Using the Advocacy Coalition Framework and Multiple Streams policy theories to examine the role of evidence, research and other types of knowledge in drug policy.

PubMed

Ritter, Alison; Hughes, Caitlin Elizabeth; Lancaster, Kari; Hoppe, Robert

2018-04-17

The prevailing 'evidence-based policy' paradigm emphasizes a technical-rational relationship between alcohol and drug research evidence and subsequent policy action. However, policy process theories do not start with this premise, and hence provide an opportunity to consider anew the ways in which evidence, research and other types of knowledge impact upon policy. This paper presents a case study, the police deployment of drug detection dogs, to highlight how two prominent policy theories [the Advocacy Coalition Framework (ACF) and the Multiple Streams (MS) approach] explicate the relationship between evidence and policy. The two theories were interrogated with reference to their descriptions and framings of evidence, research and other types of knowledge. The case study methodology was employed to extract data concerned with evidence and other types of knowledge from a previous detailed historical account and analysis of drug detection dogs in one Australian state (New South Wales). Different types of knowledge employed across the case study were identified and coded, and then analysed with reference to each theory. A detailed analysis of one key 'evidence event' within the case study was also undertaken. Five types of knowledge were apparent in the case study: quantitative program data; practitioner knowledge; legal knowledge; academic research; and lay knowledge. The ACF highlights how these various types of knowledge are only influential inasmuch as they provide the opportunity to alter the beliefs of decision-makers. The MS highlights how multiple types of knowledge may or may not form part of the strategy of policy entrepreneurs to forge the confluence of problems, solutions and politics. Neither the Advocacy Coalition Framework nor the Multiple Streams approach presents an uncomplicated linear relationship between evidence and policy action, nor do they preference any one type of knowledge. The implications for research and practice include the contestation of evidence through beliefs (Advocacy Coalition Framework), the importance of venues for debate (Advocacy Coalition Framework), the way in which data and indicators are transformed into problem specification (Multiple Streams) and the importance of the policy ('alternatives') stream (Multiple Streams). © 2018 Society for the Study of Addiction.

Autism, language and communication in children with sex chromosome trisomies.

PubMed

Bishop, Dorothy V M; Jacobs, Patricia A; Lachlan, Katherine; Wellesley, Diana; Barnicoat, Angela; Boyd, Patricia A; Fryer, Alan; Middlemiss, Prisca; Smithson, Sarah; Metcalfe, Kay; Shears, Deborah; Leggett, Victoria; Nation, Kate; Scerif, Gaia

2011-10-01

Sex chromosome trisomies (SCTs) are found on amniocentesis in 2.3-3.7 per 1000 same-sex births, yet there is a limited database on which to base a prognosis. Autism has been described in postnatally diagnosed cases of Klinefelter syndrome (XXY karyotype), but the prevalence in non-referred samples, and in other trisomies, is unclear. The authors recruited the largest sample including all three SCTs to be reported to date, including children identified on prenatal screening, to clarify this issue. Parents of children with a SCT were recruited either via prenatal screening or via a parental support group, to give a sample of 58 XXX, 19 XXY and 58 XYY cases. Parents were interviewed using the Vineland Adaptive Behavior Scales and completed questionnaires about the communicative development of children with SCTs and their siblings (42 brothers and 26 sisters). Rates of language and communication problems were high in all three trisomies. Diagnoses of autism spectrum disorder (ASD) were found in 2/19 cases of XXY (11%) and 11/58 XYY (19%). After excluding those with an ASD diagnosis, communicative profiles indicative of mild autistic features were common, although there was wide individual variation. Autistic features have not previously been remarked upon in studies of non-referred samples with SCTs, yet the rate is substantially above population levels in this sample, even when attention is restricted to early-identified cases. The authors hypothesise that X-linked and Y-linked neuroligins may play a significant role in the aetiology of communication impairments and ASD.